Anxiety disorder

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Classification according to ICD-10
F40.0 Agoraphobia
F40.1 Social phobias
F40.2 Specific (isolated) phobias
F40.8 Other phobic disorders
F40.9 Phobic disorder, unspecified
F41.0 Panic disorder (episodic paroxysmal anxiety)
F41.1 Generalized anxiety disorder
F41.2 Anxiety and Depressive Disorder, mixed
ICD-10 online (WHO version 2019)

Anxiety disorder is a collective term for anxiety- related mental disorders , the common characteristic of which is excessive, exaggerated fear responses in the absence of real external threat.

A distinction is roughly made between two forms:

  1. Diffuse, unspecific fears occur spontaneously and accidentally and have no situation or objects as a trigger.
  2. Phobias (from ancient Greek φόβος phóbos "flight; fear, horror"), on the other hand, are oriented towards concrete things and are linked to certain triggering objects, situations or rooms (e.g. animals, people or lack of space).


Fear is first of all a necessary and normal emotional excitement ( affect ), the developmental origin of which lies in a protective function ( fight-or-flight reaction ). The psychiatrist and philosopher Karl Jaspers describes fear as “a common and painful feeling. Fear is directed towards something, fear is irrelevant. "

The differentiation of a non-specific anxiety disorder, on the other hand, is often difficult and is defined differently by different authors. On the other hand, the definition of the phobia and the delimitation of the phobias from one another are clearer and simpler. Phobias are over-valued specific fears of certain objects, living beings or situations. The psychoanalysis interprets the phobia than the defense ( shift ) of an internal conflict to a particular object.

A disturbance of fear experience, after the findings of risk research but also in a too low level of anxiety exist, which may be tempted by uncontrollable risk actions. In contrast to oversized fears, however, there is usually no direct psychological stress and thus no motivation for treatment.

Volker Faust (1995) names the following criteria for differentiating “ pathological fears” (in the sense of a disorder) from the various “appropriate fears”:

  • the "inappropriateness" of the fear response to the threat sources (i.e., no real threat)
  • the severity of symptoms (such as high fear intensity and long persistence of fear ( persistence ))
  • Inability to control or endure anxiety on your own
  • a sudden onset with mostly physical symptoms


Classification of the WHO

In Germany and most European countries, the classification of the World Health Organization (WHO) is used for the classification and diagnosis of mental disorders ( Chapter V of the ICD ). Although fear is an "affect" and the ICD-10 is a modern classification system that anxiety disorders are (including panic attacks and phobic disorders) are not counted there to the mood disorders ( Section F3 ).

Instead, they are listed in sub-chapter F4 ( Neurotic, Stress and Somatoform Disorders ), where a distinction is made between agoraphobia , social phobias and specific (isolated) phobias. In agoraphobia, a further distinction is made between agoraphobia without panic disorder and agoraphobia with panic disorder. The specific phobias can also be further divided into the following subtypes:

  • Animal type (e.g. spiders, cats),
  • Force of nature type (e.g. thunderstorm, water),
  • Blood injection / injury type (e.g. injection by syringe),
  • situational type (e.g. airplane, elevator),
  • other unspecified types.

In the course of time and the further development of diagnostic classification systems, some of the disorders that were initially classified as phobic disorders have been classified more precisely or elsewhere. For example, the WHO no longer counts (non-delusional) dysmorphophobia and nosophobia as phobic disorders, but as hypochondriac disorders . There are also some research results with regard to agoraphobia that call for a different classification (see the US DSM-5). At the same time, fear is symptomatically in the foreground in these clinical pictures.

Since, in principle, specific phobias can develop against all conceivable situations or objects, a special name for each phobic disorder is hardly meaningful, even within the specific phobias. On the other hand, it is important for medical treatment to document the exact triggering phobic stimuli (e.g. spiders, elevators), since behavior therapy works among other things with the confrontation with the fear-inducing phobic stimuli.

People with anxiety disorders often do not perceive fear as the most prominent symptom themselves. Instead, physical symptoms are often mentioned first, such as dizziness, rapid heartbeat, tremors, reduced resilience or gastrointestinal complaints.

The division in the ICD-10 is as follows:

Phobic disorders

Other anxiety disorders

  • Panic Disorder (ICD-10 F41.0): Spontaneous anxiety attacks that are not related to a specific object or situation. They start abruptly, peak within a few minutes, and last at least a few minutes.
  • Generalized anxiety disorder (ICD-10 F41.1): A diffuse fear with tension, apprehension and apprehension about everyday events and problems over a period of at least six months, accompanied by other psychological and physical symptoms.
  • Anxiety and depressive disorder, mixed (ICD-10 F41.2): Anxiety and depression are present at the same time, rather mildly pronounced without predominating one or the other.


The focus of the diagnosis is the medical or psychotherapeutic discussion. Based on the symptoms described, the psychiatrist or psychological psychotherapist can make an initial suspected diagnosis.

In order to be able to distinguish physical symptoms of fear (such as shortness of breath and palpitations) from an organic disease, a detailed medical examination must first be carried out to rule out a physical cause. This usually also requires laboratory and technical examinations (blood tests, EKG and similar). A mental disorder should only be diagnosed and treatment planned after a physical illness has been ruled out.

The following criteria speak for an anxiety disorder:

  1. The fear is clearly not appropriate to the situation.
  2. The corresponding fear reactions last much longer than would be necessary.
  3. The particular type of fear cannot be explained, influenced or overcome by those affected.
  4. The fears lead to significant impairments in the lives of those affected.
  5. The fears limit contact with strangers.

General symptoms

Every fourth patient with anxiety disorder complains of chronic pain .

Appropriate questionnaires

"Symptom -specific scales such as the Hamilton fear scale (HA-MA) are no longer used for diagnostics (because then they would compete with ICD or DSM), but only for determining the severity." According to the S3 guideline, global measures, how the Clinical Global Impression (CGI) are used. The following questionnaires are also mentioned:

Form of anxiety disorder External assessment Self-assessment
Panic disorder / agoraphobia PAS ( Panic and Agoraphobia Scale ), external assessment (Bandelow, 1999)

PDSS ( Panic Disorder Severity Scale ) (Shear et al., 1997)

PAS, self-assessment (Bandelow, 1999)
generalized anxiety disorder HAMA ( Hamilton fear scale ) (Hamilton, 1959) BAI ( Beck Anxiety Inventory ) (Beck et al., 1961)
social phobia LSAS ( Liebowitz Social Anxiety Scale ) (Liebowitz, 1987) LSAS (Liebowitz, 1987)
specific phobia FQ ( Fear Questionnaire ) (Marks, 1987)


Anxiety disorders show a high level of comorbidity - both with one another and with depression , somatoform disorders and substance use disorders (intrapersonally controlled use of psychotropic substances). The likelihood of developing another disorder is highest with panic disorder and agoraphobia. Secondary depression is most common in panic disorder, followed by generalized anxiety disorder and agoraphobia. Substance use disorders resulting from an anxiety disorder are considered an attempt at self-medication.


Specific phobias

In the case of specific (isolated) phobias, the anxiety symptoms develop in relation to a specific object, situation or place. There is a significant emotional burden from the anxiety symptoms. The objects or situations that cause fear are avoided. At the same time, there is an understanding that the fears are exaggerated or unreasonable. When looking at the fear-inducing object or situations, the symptoms described above occur.

When naming, the word part "-phobia" is attached to the fear-inducing object: Allium phobia (fear of garlic), nosocomiophobia (fear of hospital), hydrophobia (fear of water, fear of water), thanatophobia (fear of death) etc.

There are many possible phobias as phobic responses can target practically anything. Some more well-known specific phobias are:


The term agoraphobia , which comes from the Greek, literally means "fear of the marketplace". It is a fear of leaving your home, going into shops, going into a crowd, public places, or traveling alone on trains, buses, or planes. In such situations, those affected often panic looking for a possible escape route.

Agoraphobia is often confused with claustrophobia (fear of space), the fear of being locked in. In general, it means a fear of public spaces, crowds or situations in which it seems difficult to escape or help. This type of fear is particularly acute when the person is alone in these places. People suffering from agoraphobia therefore avoid public transport, long car journeys on highways or remote country roads, but also a stroll through the city center. In some cases, those affected are only able to cope with everyday demands when accompanied by a trusted person. In severe cases, isolation occurs, for example if the house or apartment as protective rooms can no longer be left or can no longer be left.

Agoraphobia often occurs in conjunction with what is known as panic disorder . It is therefore assumed that agoraphobia does not develop through model learning and classical conditioning like the specific phobias, but occurs as a result of a panic disorder.

Social phobia

In the case of social phobia, those situations are fearful in which those affected are the focus of attention and are subjected to scrutiny by other people. It is feared that they will behave in an embarrassing or degrading manner, which usually leads to avoidance of social situations.

Possible symptoms are:

  • Fears of showing up in certain social contexts
  • Fear of being recognized in this fear and being publicly shamed or condemned
  • Physical reactions before and in fearful situations (racing heart, sweating, nausea, shortness of breath, voice failure, etc.)
  • Avoidance behavior, thereby often more pronounced deficits in the maturation process (of the adolescent) and deficits in the perception of social responsibility
  • often as a result decreased self-confidence, feelings of failure, feelings of inferiority, fear of criticism
  • Blushing , trembling of the hands, avoidance of eye contact, nausea, including urination

A closely related image with a smooth transition to social phobia is so-called erythrophobia , the fear of blushing (in the presence of others). There is also paruresis , which prevents people - especially men - from urinating in public.

Panic disorder

Panic disorders are characterized by repeated severe impulsive anxiety or panic states that are not limited to specific situations and are therefore not predictable. Panic attacks are particularly often accompanied by sudden palpitations, racing heart or irregular heartbeat. You may also experience chest pain, choking, tremors, sweating, dizziness and a feeling of alienation. Those affected are scared to death, for example fear of cardiac arrest or heart attack. Feelings of derealization and the fear of going crazy also occur again and again . Then there are the other symptoms described.

These attacks usually only last a few minutes, sometimes a little longer. Because these situations arise suddenly and unpredictably, a fear of fear eventually arises. It is specific to panic disorder that sufferers often fail to recognize the connection between the physical symptoms and their anxiety and misinterpret the symptoms.

Generalized anxiety disorder

Generalized anxiety disorders summarize persistent symptoms of anxiety that are also not limited to specific situations. The following symptoms occur: nervousness, tremors, muscle tension, sweating, drowsiness, palpitations, hyperventilation, difficulty swallowing, dizziness, upper abdominal discomfort, restlessness, concentration disorders, irritability and difficulty falling asleep due to constant anxiety and fear. Those affected often do not know what triggered their fear. For example, they are tormented by the fear that they or their loved ones might get sick or have accidents.

Anxiety and depressive disorder

In addition to the symptoms of anxiety, there are those of depression . It has been found that anxiety symptoms, which are often not recognized as these at first, can also lead to depression. You feel bad because initially no doctor can help and no physical causes can be found. It can therefore happen that you persuade yourself to have some serious physical illness (tumor, etc.) and thus suffer even more. This can build up to depression over time.

The finding that fear of being limited in one's own performance and ability to withstand stress often leads to the fact that those affected feel inferior or weak. Added to this is the shame about the visible symptoms or about not “functioning fully”.


According to recent studies, specific (isolated) phobias are quite common in the population. Yet only a small proportion of those affected seek professional help. It is not easy to determine the frequency, since the simple phobias in particular do not always interfere with everyday life. The lifetime prevalence is about 11 percent for the simple phobias, about 13 percent for the social phobia, and about 5 percent for the agoraphobia. In general, anxiety disorders occur about twice as often in women as in men; the difference is particularly pronounced in agoraphobia.

Anxiety disorders are relatively common in everyday psychiatry. According to a 1996 study by the WHO , around 8.5% of patients in German general practitioners' practices suffered from generalized anxiety disorder and 2.5% from panic disorder. Half of all people with panic disorders also suffer from agoraphobia. Nearly 20% of patients who presented to general medicine hospitals in the United States had an anxiety disorder, 41% of them untreated.


As with most mental disorders, there are no conclusive findings on the causes of the group of anxiety disorders. A large number of causative or triggering factors are currently assumed, which only in combination and interaction cause the actual outbreak of the disorder (see vulnerability-stress model ). Other causes are being researched depending on the psychiatric or psychotherapeutic school. All theoretical orientations recognized in the professional world contribute from their special point of view to researching the cause and origin (development) of these disorders.

Psychological models

Since Charles Spielberger (1966), fear psychology has differentiated between

  • a so-called "trait fear", which represents a relatively stable, consistent character trait and
  • a so-called "state fear", which occurs as a temporary emotional state depending on the situation and environment.

Personality models of psychology, which are designed dimensionally, essentially agree on the assumption that there is a kind of genetic disposition to "fearfulness" which, if it is strong (dimensioned), represents a weak point (vulnerable area) in the psychological constitution that leads to An anxiety disorder can become a crystallization point. According to Siegbert Warwitz , the “strategic goal of self-education” must be “to transform as many of the fears that arise by chance into fear that can be better controlled and treated.” In contrast to the diffuse fears, the fear- inducing factor can by definition be fixed.

Cognitive Schemas

It is undisputed that people who suffer from increased fear perceive the world differently and sometimes distorted. In the long run, this distorted perception then turns into a false “evaluation” of the outside world. In cognitive therapy, one speaks of the development and establishment of so-called “maladaptive cognitive schemata”, that is, a kind of internalized “prejudice” or at least “wrong judgment” about the dangerousness of the world. In a further step there is then an inappropriately strong "avoidance behavior" in order to avoid these supposedly threatening dangers. This “avoidance behavior” in turn leads to a more or less strong, often progressive narrowing of the radius of action and the activities in general, in the further step often to withdrawal and isolation. As a rule, the person concerned remains more or less far behind his actual social performance. This makes it difficult or impossible to acquire reliable social skills.

Development models

It is known from developmental psychology and from daily experience with children that there are certain “typical” and “age-related” fears. Kapfhammer (2000) calls this “being strangers”, “fear of separation”, “fear of school”, “fear of animals”. He points out that there are connections between

  • the later occurrence of panic disorder or agoraphobia on the one hand and early childhood separation fears (Bolwby, 1976) or separation fears and school phobia (Gittleman and Klein, 1984) on the other
  • the later occurrence of a generalized anxiety disorder on the one hand and early familial trauma "(conflicts between parents, conflicts with parents, sexual trauma, insufficient attention, low family prestige, stronger physical punishment)" (Angst and Vollrath, 1991), respectively. Growing up in a family with alcoholics (Mathew et al. 1993; Tweed et al. 1989) on the other hand
  • the later appearance of phobias on the one hand and childish fear of shame in the case of high parental demands (Parker, 1979), socio-phobic exemplary behavior of the mothers (Bruch et al. 1989) or exaggerated concern of the parents from criticism from outsiders (Bruch and Heimberg, 1994) on the other.

Learning theory models

The approach developed by Orval Hobart Mowrer assumes that fears arise through (classical and operant) “conditioning” in the sense of pathological (= pathological, inadequate) fear reactions to originally neutral stimuli that become real through temporal and / or spatial contingency fear-inducing situation become a conditioned fear stimulus within the framework of learning experiences. Avoiding this situation avoids the stimulus and thus also reduces anxiety. This leads to a negative reinforcement of the avoidance behavior, i.e. H. the individual “learns” that avoidance is good for them by protecting them from emerging fears.

As with the cognitive schemas (see above), it is a misadapted, i.e. H. Learning that is not realistic, in which it is no longer possible to differentiate between the actual source of fear and the symbolic stimulus. Due to the persistent avoidance, there is no corrective learning experience, so that the pathological fear reaction "establishes" itself.

In panic disorder, a positive feedback “between physical sensations (e.g. perceived change in heart rate) and cognitive assessment processes as a danger (e.g.“ impending heart attack ”) with a resulting escalating fear reaction” plays a major role.

Particularly important in the development of a generalized anxiety disorder (Blazer, 1987), but also a panic disorder (Finlay-Jones and Brown, 1981; Goldstein and Chambless, 1978; Faravelli and Pallanti, 1989) comes serious, negative (and traumatizing) life events (so-called life events ).


Sigmund Freud knew the phenomenon of fear in two contexts:

  • as an expression or as a result of an internal psychological conflict, for example between a forbidden instinctual impulse and a strict conscience. According to this, fear results from the incomplete suppression of a wishful impulse, e.g. B. a sexual desire and the fear of punishment, it is the result of a defensive process (Freud, 1895).
  • as signal fear. In this function, fear signals to the ego the presence of an internal threat, e.g. B. by similar conflicts as mentioned above. It then stands at the beginning of a protective measure by the ego and is thus the initiator of a defense process (Freud, 1926).

According to psychoanalytic understanding, the development of a phobia is first and foremost an active psychological achievement, and in particular the result of an intrapsychic defense: fearful consciousness contents are suppressed, whereby the original contents (it can be ideas or Acting feelings) insignificant external situations are set. The fear is thus shifted to another “harmless” place to which the “actual (forbidden and therefore fearful and repressed) content” can no longer be viewed and assigned. Even the person concerned is no longer aware of the shift; he, too, is amazed at where the fear comes from.

It should be noted that the phobia is more than simple repression. This would not be sufficient for an acceptable solution. As a result of the repression of the specific conceptual content, the previously bound and directed fear experiences a regression into an unbound, dedifferentiated, diffuse fear, which is extremely difficult to bear because of its chance occurrence. In a second phase, the main defense mechanism of the phobic mode, namely the postponement, must therefore be used, whereby the attachment to a new content is achieved “artificially”. Greenson once put it this way: "One form of fear is used as a defense against another fear."

The advantage of the displacement mechanism is that an external hazard is constructed from the original internal hazard: an external hazard has the “advantage” that it can be avoided more easily than an internal one.

As with all neurotic attempts at a solution, the phobia is also a compromise, which consists in the fact that, on the one hand, the forbidden desires and strivings can remain unconscious and do not take effect, in a distorted way, namely as a phobic reaction, but nevertheless can be partially lived out.

Field theoretical approach

Field theoretical models in the sense of the gestalt psychologist Kurt Lewin represent an intermediate position to the models already mentioned . He defined experience and behavior as a function of person and environment. Accordingly, this approach looks at three different perspectives when it comes to fearful events: first, the patient, second, the object of fear, and third, the relationship between patient and object of fear. These three perspectives also correspond to three possible starting points for therapeutic treatment, which can be selected according to the situation and patient: strengthening ("enlarging") the patient, more realistic assessment ("reducing") the fear object and changing the relationship between patient and fear object (" Encouragement ”), whereby the influence of other people can also assume a temporary support function. The approach arises from Lewin's suggestions in the early phase of attachment theory and attachment research . It does not contain a case-independent stipulation on a specific etiology of the anxiety process.

Biological foundations


Family and twin studies showed that the heredity of anxiety disorders is around 30%. Genetic studies yielded varied evidence for an involvement of gene variations in the serotonin - dopamine - norepinephrine - and adrenaline - neurotransmitters , for example, the genes for 5-HTT , 5-HT1A and MAOA .


Patients with generalized anxiety disorder showed abnormal activity in the prefrontal cortex and amygdala , as well as decreased signal traffic between these areas. At the same time, the volume of the two regions was increased, but the anatomical connections between them decreased.

In the case of social phobia, treatment successes - regardless of the type of therapy - showed changes in the activity and signaling of the amygdala towards normalization.


The following neurotransmitter systems (chemical messenger systems) are mainly involved in the neurochemistry of anxiety disorders .

Thyroid malfunction

There are indications that both overactive thyroid (cause: mostly Graves disease or thyroid autonomy ) and underactive (cause: mostly Hashimoto's thyroiditis ) of the thyroid can in rare cases be linked to anxiety disorders.

Treatment options

Various treatment methods are used in the therapy of anxiety disorders; primarily psychotherapy (behavior therapy or, less often, depth psychological methods) and pharmacotherapy. With the current S3 guideline on anxiety disorders, there is a scientifically founded consensus on treatment.

Anxiety disorders usually result from a disproportion between the external assessment of the situation and one's own subjective well-being. Therefore, according to the Yerkes-Dodson law of fear, psychotherapeutic treatment aims to deal with excessive fears in a regulated, mentally and emotionally controlled manner. This is about an adequate control of fear, but not about complete freedom from fear, because the subjective perception of danger and the warning system must be maintained before the personally beneficial risk.

Behavior therapy

In behavior therapy for phobias, anxiety and panic disorders, v. a. It is about exposing oneself to fears and fear-filled situations in a targeted manner and in increasing doses, until all previously avoided situations can be mastered again and integrated into normal life. The stimulus confrontation is used for this , which can take place in two forms.

  • Overstimulation ("flooding") : A confrontation with a maximally fear-inducing situation takes place under parallel therapeutic support, which must be endured until a physiological habit occurs and the patient learns that the dreaded catastrophic consequences will not occur. In the German-speaking countries, this procedure is largely dispensed with due to ethical concerns.
  • Graduated stimulus exposure : systematic desensitization through stepwise increased stimulus exposure until all hierarchical levels have been passed through to the maximum

In cognitive therapy , which is often combined with classic behavioral methods, the patient should change his or her thinking and evaluation style. The theoretical basis is the assumption that, above all, a "wrong assessment" of the fear-inducing situation provokes and continues to intensify the intense fear and avoidance reaction. The question of the finality of fear can be very helpful: What does the patient want to achieve (unconsciously) with his fear?

Depth psychology

Psychoanalytic and depth psychological psychotherapy procedures are based on the theoretical basic assumptions of psychoanalysis, according to which the anxiety symptoms are an expression of an unconscious conflict with an unsuccessful compromise solution. The uncovering of this conflict and the "working through" reactivating the original affects should make the fear affect superfluous and make it disappear again.

Relaxation procedure

Fears are usually from physical symptoms, v. a. also accompanied by tension, which in turn has a negative effect on the symptoms of anxiety and the physical symptoms and intensifies or at least maintains them. That is why an important approach to anxiety therapy is releasing tension through relaxation techniques. The following are used:


Anxiety-relieving drugs ( anxiolytics ) are used to treat anxiety disorders . The most commonly used groups of drugs are SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-noradrenaline reuptake inhibitors) and benzodiazepines . Overall, their effects are moderate to moderate, with benzodiazepines being more effective than the other two.

Other anxiolytics:

The above-mentioned active ingredients differ greatly from one another in terms of structure, effectiveness, risk of addiction and side effect profile. An anxiolytic is therefore usually prescribed by an experienced doctor.

Support groups

Unless the illness itself causes difficulties for the person affected, self-help groups can be a very important addition to the forms of treatment and / or help ensure the success of treatment after the end of treatment. In recent years the internet has also been used in a variety of ways to help those affected.


Exercise can help reduce symptoms of anxiety. However, sport cannot replace drug and psychotherapeutic treatment. However, a lot of exercise can complement medical measures, because studies have shown that physical training can have a similar effect to drug therapy, as a significant connection between mental satisfaction and physical activity could be established.

However, due to the limited number of control studies, no completely unquestionable connection with the effectiveness of sport as a psychotropic drug can be proven. The improvement in the mental state could also be attributed to other factors, such as increased attention during the experiment or the participants' own expectations of the effect, which lead to mental health. Therefore, it cannot be ruled out that the general conditions of physical activity have a significant influence on the result. It was found that people who do sports are consistently less anxious than people who are inactive. It is unclear whether doing sports really keeps you mentally healthy or whether your mental health is the basis for wanting to do sports. For this reason, further studies are to follow in order to clarify the connection in a scientifically verifiable manner and to find out to what extent sport can have a healing effect.

Theories of how exercise can improve mental health

  1. One of the most common explanations is the observation that increased growth factors such as BDNF or IGF-1 are released during physical activity . Research has shown that exercise and antidepressant medication increase the concentration of messenger substances in the blood, which people with anxiety disorders often lack. Researchers suspect that a lack of BDNF contributes to the symptoms of depressive illness, such as difficulty concentrating. Since cognitive disorders shape the picture of anxiety disorders and depression, it is conceivable that exercise can have a positive effect on the clinical picture by improving these symptoms. BDNF is also a prerequisite for the brain to form new neural connections.
  2. According to neuroscientist Stefan Schneider from the Sport University in Cologne, endurance sports reduce activity in the prefrontal cortex , where emotional stimuli are converted into conscious feelings. In addition, the motor cortex is activated, which is responsible for planning and logical thinking. Physical activity thus shifts brain activity. Think of it as resetting a computer whose memory is overloaded. The restart enables you to concentrate better and focus your attention on relevant content.
  3. In people with anxiety disorders and depression, anxiety often leads to less exercise. This will remove existing symptoms such as B. Heart palpitations and sweating intensified, as the body has hardly any fitness and is therefore quickly overwhelmed. By motivating people to do more physical activity, this vicious circle could be broken and patients would be able to face possible anxiety problems.
  4. For those affected by anxiety, exercise and sport can often be viewed as a kind of behavioral confrontation exercise. In such cases, sport and exercise are small challenges from this point of view, through which the patient learns to overcome fears. "In the case of anxiety disorders, it is therapeutically crucial that the patient confronts their fear. It is important to get through complaints and learn that ultimately there is no danger. That is the most important thing." This allows those affected by fear to gain new hope. The new hope opens up the possibility for the patient to see a way out, which reduces the experience of stress, which can have a health-promoting effect.
  5. There are also some assumptions on a biological level as to how exercise and sport can have beneficial effects on anxiety disorders. The main focus is on the effects to be registered in the brain. One of the oldest findings is that cerebral blood flow increases significantly even with slight movement. It has been proven that the brain is better supplied with oxygen during physical activity. "Even when walking, the blood flow to the brain can be increased by around 20 percent, with moderate stress by up to 30 percent. As a result of the increased blood flow, not only oxygen but also biochemical substances are better transported."
  6. In most anxiety disorders and depression, the body's stress system is overly active, which leads to an imbalance in the autonomic nervous system. Endurance sports can strengthen the parasympathetic nervous system and thus contribute to a healthy balance in the autonomic nervous system. In the event of an imbalance, the signals from the activating sympathetic system dominate over the signals from the calming parasympathetic system. This is also reflected in a reduced heart rate variability . Depressed people also have a reduced heart rate variability, which also improves with successful therapy.
  7. The overactivity of the stress system of those affected by anxiety is also associated with a permanently increased release of cortisol in the body. A permanently high level of cortisol has some unfavorable consequences, such as the loss of nerve cells in the hippocampus . Researchers like Florian Holsboer believe that an excess of cortisol contributes significantly to the development of depression. Endurance sports seem to be able to lower the cortisol level in the body or prevent increases in cortisol.
  8. It is also worth mentioning that there is evidence that physically trained brains require less brain capacity than untrained brains to complete tasks .
  9. Exercise can increase the effects of other measures, such as the effects of antidepressants . Two clinical studies have shown that patients who had not responded adequately to antidepressant medication experienced a significant improvement through the use of an additional exercise program.
  10. Through the rhythmic activation of the two halves of the body and thus the hemispheres of the brain, exercise contributes to better information processing in the brain and body. This finding comes from trauma research, where numerous reliable studies meanwhile show that sensual stimulation that regularly changes the side of the body not only favors the processing of psychological trauma, but also the stabilization of positive ideas and developments.

Difficulty performing exercise therapy

The big challenge is to motivate anxious people to exercise. This is easier if the person concerned can already look back on positive movement experiences in their life and therefore only need to be reminded of the abilities they already have. If possible, you should build on a previous sport, but if this is not possible, find and recommend a comparable one. Such motivation is more difficult with inexperienced people who are often even more averse to sporting activities. However, by conducting a motivational conversation it is possible to help those affected to find new attitudes.


Anxiety disorders can include B. develop out of a "completely normal", clinically not yet relevant shyness . However, they tend to become chronified (solidified) if left untreated. In panic disorder, for example, only 10 to 30% of those affected spontaneously make full recovery (i.e. without treatment or as a result of treatment).

Psychotherapy and drug treatment usually improve the prognosis significantly. The isolated phobias are very easy to treat. Basically, the earlier a treatment is started, the more favorable it is.


Even if the term phobia was only introduced into the scientific discussion in the 19th century, it can, in retrospect, be related to diverse traditions. Phobos (the companion of the god of war Ares ) was conjured up by the Greeks before fighting. The fears that were called war neuroses in the 20th century also related to similarly specific external dangers. In religion, art and literature, fears have often been associated with the animal kingdom (animal phobia). Much of the content of mythology is expressed in animal phobias and, according to CG Jung, is characteristic of the mother archetype . They find an echo in the richness of religious feeling that is a vessel willing to revelation.

The term phobia was first used in psychiatry around 1870 and was intended to designate a key symptom of a neurosis . For psychoanalysis, the phobia was not regarded as a specific neurosis, but as a symptom of anxiety hysteria. The term "fear hysteria" was introduced in 1908 by Wilhelm Stekel at the suggestion of Sigmund Freud . Freud preferred this term as it allowed him to see sexuality at the center of the phobic symptom. Freud's idea seemed to apply particularly to hysteria, although it could also be confirmed in the obsessional neurosis and also in the anxiety neurosis , which Freud counted among the actual neuroses . Compulsive cleanliness and abstinence also serve to ward off anything sexual. Freud also found phobic symptoms in psychotic disorders. It was not until the analysis of little Hans (Herbert Graf) in 1909 that it emerged that the libido was not linked to the conversion symptom , inner psychological disturbances or the inner feeling of existential threat. Rather, fear is directed towards concrete externalized objects.

See also




  • Holger Bertrand Flöttmann : Fear. Origin and Overcoming. 6th, revised edition. Kohlhammer, Stuttgart 2011, ISBN 978-3-17-021784-3 .
  • Siegbert A. Warwitz : The field of fearful feelings. In: Siegbert A. Warwitz: Search for meaning in risk. Life in growing rings. Explanatory models for cross-border behavior. 2nd, extended edition, Verlag Schneider, Baltmannsweiler 2016, ISBN 978-3-8340-1620-1 , p. 36 ff.
  • Gerd Huber : Psychiatry. Textbook for study and further education. 7th, completely revised and updated edition. Schattauer, Stuttgart et al. 2005, ISBN 3-7945-2214-1 .
  • Horst Dilling, Werner Mombour, Martin H. Schmidt, E. Schulte-Markwort (eds.): International classification of mental disorders. ICD 10 Chapter V (F) Clinical Diagnostic Guidelines. 5th, revised and supplemented edition taking into account the changes according to ICD-10-GM 2004/2005. Huber, Bern et al. 2004, ISBN 3-456-84124-8 .
  • Gerd Laux, Hans-Jürgen Möller: Psychiatry and Psychotherapy. With the collaboration of Mirijam Fric. 2nd updated edition. Thieme, Stuttgart et al. 2011 ISBN 978-3-13-145432-4 .
  • Herbert Fensterheim : Life without fear , Goldmann 1987, ISBN 978-3442113439 .

Anxiety disorders

  • Sven O. Hoffmann , Markus Bassler: Psychodynamics and psychotherapy of anxiety disorders. In: Neurology. Volume 11, 1992, ISSN  0722-1541 , pp. 8-11.
  • Hans-Peter Kapfhammer: Anxiety Disorders. In: Hans-Jürgen Möller, Gerd Laux, Hans-Peter Kapfhammer (eds.): Psychiatry and psychotherapy. Springer, Berlin et al. 2000, ISBN 3-540-64719-8 , pp. 1185 ff.
  • Rudolf Marx: Anxiety Disorders - An Introduction. In: Wolfgang Beiglböck, Senta Feselmayer, Elisabeth Honemann (eds.): Manual of clinical-psychological treatment. 2nd, revised and expanded edition. Springer, Vienna et al. 2006, ISBN 3-211-23602-3 , pp. 197–203.
  • Axel Perkonigg, Hans-Ulrich Wittchen : Epidemiology of anxiety disorders. In: Siegfried Kasper, Hans-Jürgen Möller (ed.): Anxiety and panic disorders. G. Fischer, Jena et al. 1995, ISBN 3-334-60976-6 , pp. 137-156.
  • Maren Sörensen: Introduction to Anxiety Psychology. An overview for psychologists, educators, sociologists and medical professionals. 2nd Edition. Deutscher Studien-Verlag, Weinheim et al. 1993, ISBN 3-89271-374-X .
  • Hans-Ulrich Wittchen, Frank Jacobi: Anxiety disorders (= federal health reporting. H. 21). Robert Koch Institute, Berlin 2004, ISBN 3-89606-152-6 ( ).

Web links

Wiktionary: Anxiety disorder  - explanations of meanings, word origins, synonyms, translations
Wiktionary: Phobia  - explanations of meanings, word origins, synonyms, translations

Individual evidence

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  3. Walter B. Cannon : Anger, hunger, fear, and pain: a physiology of emotions. From d. Engl. Transl. by Helmut Junker. Ed .: Thure von Uexküll. Urban and Schwarzenberg, Munich / Berlin / Vienna 1975, ISBN 978-3-541-07031-2 .
  4. feelings and states of mind. In: Karl Jaspers. Allgemeine Psychopathologie (9th edition 1973), p. 95
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  6. Volker Faust ( ): Anxiety disorders
  7. Anxiety disorder can cause pain. In: Doctors newspaper. January 18, 2007, p. 11.
  8. a b Borwin Bandelow, Thomas Lichte et al. (2014): S3 guideline for anxiety disorders . ISBN 978-3-662-44136-7 ( [PDF] Chapter 4.7. (Diagnostics), Chapter 3.2.8 (Genetics),).
  9. Rudolf Marx: Anxiety Disorders - An Introduction. In: Beiglböck et al .: Manual of clinical-psychological treatment. 2nd edition, Springer, Vienna 2006, pp. 197–203.
  10. ^ Siegbert A. Warwitz: The field of fearful feelings. In: Ders .: Search for meaning in risk. Life in growing rings. 2., ext. Edition, Verlag Schneider, Baltmannsweiler 2016, pp. 36–37.
  11. DIMDI ICD-10 - F40.1 Social phobias. Retrieved July 23, 2020 .
  12. World Health Organization; H. Dilling W. Mombour, MH Schmidt, E. Schulte-Markwort (Ed.) (2011): International Classification of Mental Disorders. ICD-10 Chapter V (F). Diagnostic criteria for research and practice. 5th edition. Huber, Bern 2011.
  13. ^ Möller, Laux, Kapfhammer: Psychiatry and Psychotherapy. Berlin-Heidelberg 2000.
  14. Quoted after anxiety disorders often remain untreated. In: Medical Practice. May 15, 2007, p. 14.
  15. ^ Charles Spielberger (1966): Anxiety and Behavior. ISBN 9781483258362 . (GoogleBooks: p.12f. )
  16. ^ Siegbert A. Warwitz: Trait fear and state fear. In: Ders .: Search for meaning in risk. Life in growing rings. 2., ext. Edition, Verlag Schneider, Baltmannsweiler 2016, p. 35.
  17. G. Stemberger 2012: Anxiety-Specific Techniques in Gestalt Theoretical Psychotherapy. In: Phenomenal. 4 (1-2), pp. 40-45. Joseph De Rivera 1976: The structure of situations, emotion, and unreality. In: DeRivera: Field theory as Human Science Gardner Press, New York, pp. 423-457.
  18. Jean M. Arsenian 1943: Young children in an insecure situation. (PDF) In: Journal of Abnormal and Social Psychology. 38, pp. 225-249; Jean M. Arsenian (1914–2007) - Kurt Lewin and the beginnings of attachment research.
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  21. K. Hilbert, U. Lueken, K. Beesdo-Baum: Neural structures, functioning and connectivity in Generalized Anxiety Disorder and interaction with neuroendocrine systems: a systematic review. In: Journal of Affective Disorders. Volume 158, April 2014, pp. 114-126, doi : 10.1016 / j.jad.2014.01.022 , PMID 24655775 (review).
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  23. B. Bandelow, D. Baldwin, M. Abelli, B., et al .: Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition. In: The world journal of biological psychiatry: the official journal of the World Federation of Societies of Biological Psychiatry. Volume 18, number 3, 04 2017, pp. 162-214, doi : 10.1080 / 15622975.2016.1190867 , PMID 27419272 , PMC 5341771 (free full text) (review).
  24. D. Marazziti, M. Abelli, S. Baroni, as Carpita, CE Ramacciotti, L. dell'Osso: Neurobiological correlates of social anxiety disorder: an update. In: CNS spectrums. Volume 20, number 2, April 2015, pp. 100-111, doi : 10.1017 / S109285291400008X , PMID 24571962 (review), PDF .
  25. ^ NM Simon, D. Blacker, NB Korbly, SG Sharma, JJ Worthington, MW Otto, MH Pollack: Hypothyroidism and hyperthyroidism in anxiety disorders revisited: new data and literature review. In: Journal of Affective Disorders. Volume 69, number 1-3, May 2002, pp. 209-217, doi : 10.1016 / s0165-0327 (01) 00378-0 , PMID 12103468 (review), PDF .
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  28. TK Wilson, J. Tripp: Buspirone . In: StatPearls . January 2018. PMID 30285372 .
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  31. ^ Matthew P. Herring et al .: Arch Int Med . 2010; 170: pp. 321-331, cited in Medical Tribune. March 12, 2010, p. 6.
  32. ^ University of Michigan. "Get moving to get happier, study finds." ScienceDaily. ScienceDaily, April 4, 2018. <>.
  33. K.-H. Schulz et al. 2012, pp. 55-57; see. Wegner et al. 2014
  34. ^ Z. Zhang, W. Chen: J Happiness Stud (2018). doi: 10.1007 / s10902-018-9976-0
  35. K.-H. Schulz et al. 2012, pp. 55-57; see. Wegner et al. 2014
  36. ^ E. Anderson, G. Shivakumar: Effects of exercise and physical activity on anxiety. Front Psychiatry. 2013; 4: 27. Published 2013 Apr 23. doi: 10.3389 / fpsyt.2013.00027
  39. Quoted from sports scientist K. Werner, German Sport University Cologne
  40. Florian Holsboer "Cortisol Hypothesis of Depression"
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  42. ^ A. Broocks et al .: Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder. At the. J. Psychiatry 155: pp. 603-609 (1998)
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  45. Carl Gustav Jung : The Archetypes and the Collective Unconscious. Collected Works. Walter-Verlag, Düsseldorf 1995, paperback, special edition, volume 9, 1st half volume, pp. 98 ff., §§ 159–164
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  48. ^ Sigmund Freud (1909): Analysis of the phobia of a five-year-old boy. (PDF).
  49. Wolfgang Loch: On the theory, technology and therapy of psychoanalysis. In: Thure von Uexküll, Ilse Grubrich-Simitis (ed.): Conditio humana. S. Fischer Verlag, 1972, ISBN 3-10-844801-3 .