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Anxiety and Panic Attacks

We all feel anxious sometimes when life throws stressful situations our way—a big job interview, a public speech, or an important test. However, people with anxiety disorders tend to experience intense fear, apprehension, and dread when faced with such everyday events.

Anxiety can reach such intense levels that people experience a panic attack—sudden feelings of intense fear and worry combined with overwhelming physical symptoms, such as heart palpitations, chest pain, shortness of breath, dizziness, nausea, and more. Panic attacks tend to come on suddenly but can linger long after the initial stressful situation has passed.

In people with anxiety disorders, their feelings are generally out of proportion to the actual situation. This can get in the way of your life, making it a challenge to handle work or school assignments, difficult to maintain personal relationships, and tough to parent effectively.


Several types of anxiety disorders exist, including:

  • Generalized Anxiety Disorder (GAD): Persistent and excessive worry about everyday life.
  • Panic Disorder: Recurring panic attacks.
  • Social Anxiety Disorder: Intense fear and avoidance of social situations.
  • Phobias (such as agoraphobia or claustrophobia): Irrational fear and avoidance of places or situations that may cause powerful reactions of panic.
  • Separation Anxiety Disorder: In children or adults, an intense anxiety about being separated from the important people in your life.
  • Substance/Medication-Induced Anxiety Disorder: Excessive anxiety related to using or abusing drugs or medications or involving withdrawal from substances.
  • Selective Mutism: Generally seen in children, a failure to speak in public even though they can do so at home with family.


Anxiety disorders are the most common mental health condition in America. Every year, 40 million American adults—over 18% of the population—experience anxiety. The condition is more common in women, who are almost twice as likely as men to develop anxiety disorders during their lifetime. Anxiety also affects nearly 1 in 3 teens ages 13-18, and research shows that number is rising. The condition is also seen more commonly in people with ADD/ADHD than in the general population.


Untreated anxiety can steal your life. It increases your risk of depression and puts you at greater risk of suicide. People with intense fears and panic are prone to substance abuse as they may use alcohol or other substances to self-medicate their feelings. And having anxiety also makes you more vulnerable to physical ailments, such as common colds and flu bugs.


In traditional psychiatry, where diagnoses are based solely on symptom clusters, anxiety disorders and panic attacks can be misdiagnosed for other conditions, such as ADD/ADHD, bipolar disorder, autism spectrum disorder, or schizophrenia. An inaccurate diagnosis and improper treatment can exacerbate your symptoms and keep you mired in paralyzing anxiety.

Part of the problem is that traditional psychiatry typically takes a one-size-fits-all approach to diagnosis and treatment. But anxiety isn’t a simple or single disorder. Giving everybody the same treatment will never work. Beware that traditional treatment with antianxiety medications can be harmful to the brain. For example, benzodiazepines suppress brain activity and can make the brain look toxic (shriveled or low in activity), and they have been found to increase the risk of dementia.


Brain imaging studies clearly show that anxiety disorders are not a character flaw or personal weakness. They are associated with biological changes in the brain. Our brain imaging work at Amen Clinics has helped us identify 7 different brain patterns associated with anxiety. And each type requires its own treatment plan.


Pure Anxiety often results from too much activity in the basal ganglia, setting one’s “idle speed” on overdrive.

Common symptoms of Pure Anxiety include:

  • Frequent feelings of nervousness or anxiety
  • Panic attacks
  • Avoidance of people or places due to a fear of having anxiety or panic attacks
  • Symptoms of heightened muscle tension (headaches, sore muscles, hand tremor)
  • Periods of heart pounding, nausea, or dizziness
  • Tendency to predict the worst
  • Multiple persistent fears or phobias (such as dying or doing something crazy)
  • Conflict avoidance
  • Excessive fear of being judged or scrutinized by others
  • Being easily startled or a tendency to freeze in anxiety-provoking or intense situations
  • Shyness, timidity, and getting easily embarrassed
  • Biting fingernails or picking skin


Depression and anxiety occur together 75% of the time, and for this reason, we include depression as one of the 7 types of anxiety. See the brain findings and symptoms of Pure Depression.


Mixed Anxiety/Depression involves a combination of both Pure Anxiety symptoms (listed above) and Pure Depression symptoms. This type shows excessive activity in the brain’s basal ganglia and the deep limbic system. One type may predominate at any point in time, but symptom of both are present on a regular basis.


Over-Focused Anxiety/Depression involves excessive activity in the brain’s anterior cingulate gyrus, basal ganglia, and/or the deep limbic system. People with this type—which occurs more frequently in the children or grandchildren of alcoholics—have trouble shifting attention and often get locked into anxious and/or negative thoughts or behaviors. This can look like:

  • Obsessive-compulsive disorder (stuck on negative thoughts or actions)
  • Phobias (stuck on a fear)
  • Eating disorders (stuck on negative eating behavior)
  • Posttraumatic stress disorder or PTSD (stuck on a past traumatic event)

Common symptoms of Over-focused Anxiety/Depression include 4 symptoms from Pure Anxiety (listed above) and/or Pure Depression, plus at least 4 of the following:

  • Excessive or senseless worrying
  • Upset when things are out of place or things don’t go the way you planned
  • Tendency to be oppositional or argumentative
  • Tendency to have repetitive negative or anxious thoughts
  • Tendency toward compulsive or addictive behaviors
  • Intense dislike for change
  • Tendency to hold grudges
  • Difficulty seeing options in situations
  • Tendency to hold onto own opinion and not listen to others
  • Needing to have things done a certain way or you become upset
  • Others complain you worry too much
  • Tendency to say “no” without first thinking about the question


Temporal Lobe Anxiety/Depression is related to too little or too much activity in the temporal lobes (involved in moods, emotions, and memory), in addition to overactivity in the basal ganglia and/or deep limbic system.

Common symptoms of Temporal Lobe Anxiety/Depression include 4 symptoms from Pure Anxiety (listed above) and/or Pure Depression, plus at least 4 of the following:

  • Short fuse or periods of extreme irritability
  • Periods of rage with little provocation
  • Often misinterpreting comments as negative when they are not
  • Periods of spaciness or confusion
  • Periods of panic and/or fear for no specific reason
  • Visual or auditory changes, such as seeing shadows or hearing muffled sounds
  • Frequent periods of déjà vu
  • Sensitivity or mild paranoia
  • Headaches or abdominal pain of uncertain origin
  • History of head injury
  • Family history of violence or explosiveness
  • Dark thoughts that may involve suicidal or homicidal thoughts
  • Periods of forgetfulness or memory problems


Cyclic Anxiety/Depression is associated with extremely high activity in the brain’s basal ganglia and/or deep limbic system. These areas of excessive activity act like “emotional seizures” as the emotional centers hijack the brain for periods of time in a cyclical pattern. Cyclical disorders, such as bipolar disorder, cyclothymia, premenstrual tension syndrome, and panic attacks are part of this category because they are episodic and unpredictable.

Common symptoms of Cyclic Anxiety/Depression include 4 symptoms from Pure Anxiety (listed above) and/or Pure Depression plus periods of time with at least 4 of the following:

  • Abnormally elevated, depressed or anxious mood
  • Decreased need for sleep, feeling energetic on dramatically less sleep than usual
  • Grandiose notions, ideas or plans
  • Increased talking or pressured speech
  • Racing thoughts
  • Markedly increased energy
  • Poor judgment leading to risk taking behavior (departure from usual behavior)
  • Inappropriate social behavior
  • Irritability or aggression
  • Delusional or psychotic thinking

Type 7: Unfocused Anxiety/Depression

Unfocused Anxiety/Depression is associated with low activity in the prefrontal cortex (PFC) in addition to high activity in the basal ganglia and/or deep limbic system. The PFC is involved with attention, focus, impulse control, judgment, organization, planning, and motivation. When the PFC is underactive, people often have problems with these executive functions.

Distinguishing Unfocused Anxiety/Depression from ADD/ADHD can be difficult because of the similarity in symptoms. However, brain imaging provides a window into the brain to see the areas with too little or too much activity. This allows for a more accurate diagnosis.

Symptoms of Unfocused Anxiety/Depression include at least 4 items from the Pure Anxiety (listed above) and/or Pure Depression symptoms, plus at least 4 of the following:

  • Trouble staying focused
  • Spaciness or feeling in a fog
  • Overwhelmed by the tasks of daily living
  • Feeling tired, sluggish or slow moving
  • Procrastination, failure to finish things
  • Chronic boredom
  • Distractibility
  • Forgetfulness
  • Difficulty expressing feelings
  • Lack of empathy for others

A variation of Unfocused Anxiety/Depression is caused by overall reduced blood flow and activity in the cortex along with too much activity in the basal ganglia and/or deep limbic system. This pattern may be related to physical illness, drug or alcohol abuse, hypoxia (lack of oxygen), infections (such as Lyme disease), traumatic brain injury, or exposure to toxic mold or other environmental toxins. Symptoms of this variation also include frequent feelings of sickness, mental dullness, “brain fog,” or cognitive impairment.


Amen Clinics uses brain SPECT imaging as part of a comprehensive evaluation to more accurately diagnose your anxiety type so you can get a personalized treatment plan for your needs, including natural supplements, nutrition, exercise, helpful forms of therapy, simple tools to kill the ANTs (automatic negative thoughts), and medication (when necessary).

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