Unlike traditional psychiatry, which rarely looks at the brain, Amen Clinics uses brain imaging technology to identify brain patterns associated with the 7 types of anxiety.

What is Anxiety?

It is normal for everyone to feel anxious at times, especially when faced with new or stressful situations, such as moving to another state, changing jobs, or giving an important presentation. However, people who have an anxiety disorder tend to worry and feel nervous about everyday responsibilities and events, and it can be difficult for them to manage stress. Their excessive worry and anxiousness are disproportionate to circumstances that don’t pose a threat.

Who has Anxiety?

Anxiety disorder is the most common mental illness in the U.S. Every year, 40 million American adults—more than 18% of the population—develop some form of anxiety. The condition is more common in women, who are almost twice as likely as men to develop an anxiety disorder during their lifetime. Nearly 1 in 3 teens ages 13-18 also have anxiety, and research shows that number is rising. This condition often co-occurs in people who have ADD/ADHD, as well as those who struggle with depression.

What are the Core Symptoms of Anxiety?

People with anxiety disorders, can easily become very fretful, nervous, and worried—some may even have panic attacks. Many also have physical symptoms such as a racing heart, trembling hands, dizziness, muscle tension, and more. It can be hard for them to ease anxiety symptoms, which can interfere with day-to-day functioning, making it a challenge to manage the demands of work, school, and personal relationships, and can interfere with the ability to parent effectively. The symptoms of anxiety disorders tend to be persistent across multiple domains of a person’s life.

What Causes Anxiety?

There are multiple genetic and environmental factors that increase the risk for anxiety. The strong genetic component is greater than 30%. Adverse childhood experiences as well as parenting styles, such as being overprotective or very controlling also increase the risk for developing anxiety. In addition, anxiety symptoms can emerge as a result of a head injury, side effects from a prescribed medication, hormonal imbalances, blood sugar issues, substance abuse, medical illnesses, and psychosocial stressors.

Untreated anxiety can steal your life and increase the risk of:

Why Choose Amen Clinics for Treating Anxiety?

In traditional psychiatry, where diagnoses are based solely on symptom clusters in the Diagnostic and Statistical Manual of Mental Disorders (DSM), doctors and other mental health professionals who treat anxiety disorders can misdiagnose them for other mental health conditions, including ADD/ADHD, bipolar disorder, autism spectrum disorder, or schizophrenia. Treating mental health conditions is a complex process. The brain imaging work done at Amen Clinics during the past three decades has helped us identify 7 types of anxiety and depression, each of which has a different brain pattern and different set of symptoms. Therefore, when it comes to the correct treatment options to reduce or relieve symptoms of anxiety, one size does not fit all. What works for one person with anxiety may not work for another—or could even make their symptoms worse! When we treat anxiety disorders, we do so with a targeted personalized treatment plan for each person. (See below for details about the 7 types of anxiety and depression.)

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Anxious Brains Work Differently

Brain imaging shows that anxiety disorders are not a character flaw or personal weakness. They are associated with biological changes in the brain. Brain SPECT scans show that overactivity in the basal ganglia is commonly seen in anxiety, but there can also be other brain areas with abnormal activity depending on which of the 7 types of anxiety/depression a person may have.

Healthy Brain Scan

Anxiety Brain Scan

SPECT (single photon emission computed tomography) is a nuclear medicine study that evaluates blood flow (activity) in the brain. Basically, it shows three things: healthy activity, too little activity, or too much activity. A healthy “active” scan shows the activity beneath the surface of the brain. Blue represents average blood flow, while red and white represent increasingly higher levels of activity. In the healthy scan on the left, the most active area is the cerebellum (located at the back/bottom part of the brain) which is a normal finding. The scan on the right is one of a person with Type 1: Pure Anxiety, and reveals overactivity in the basal ganglia, a finding that is associated with anxiety.

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The 7 Types of Anxiety and Depression

Anxiety is not a single or simple disorder. Our work with brain SPECT imaging during the past 3 decades has revealed that there are 7 brain patterns associated with anxiety and depression and that these two conditions occur together 75% of the time. This section provides greater detail about each of the 7 types.

Type 1: Pure Anxiety

As mentioned above, Pure Anxiety often results from too much activity in the basal ganglia, setting one’s “idle speed” on overdrive. At times, anxiety worsens for seemingly no particular reason, and managing anxiety symptoms can be difficult.

Common symptoms of Pure Anxiety include:

  • Frequently feeling nervous or anxious
  • Excessive and constant worry and a tendency to predict the worst
  • Symptoms of heightened muscle tension, such as headaches, sore muscles, or trembling hands
  • Rapid heartbeat, nausea, dizziness, or other physical health problems
  • Multiple persistent fears or a specific phobia
  • Conflict avoidance
  • Excessive fear of being judged or scrutinized by others
  • Being easily startled
  • Tendency to freeze in anxiety-provoking or intense situations
  • Panic attacks
  • Avoidance of people or places due to an intense fear of having a panic attack in public (agoraphobia)
  • Being shy or timid, and getting easily embarrassed (social anxiety disorder or social phobia)
  • Biting fingernails or picking skin

Type 2: Pure Depression

Since depression and anxiety frequently occur together, depression is included in this list of the 7 types. Pure Depression often results from overactivity in the deep limbic system—the brain’s emotional center. People with this type struggle with depressive symptoms that range from chronic mild sadness (dysthymia) to crippling major depression that can make it feel almost impossible to get out of bed.

Common symptoms of Pure Depression include:

  • Persistent sad or negative mood
  • Loss of interest in activities that are normally enjoyable, including sex
  • Restlessness, irritability, or excessive crying
  • Feelings of guilt, worthlessness, helplessness, or hopelessness
  • Sleeping too much or too little, or early-morning awakening
  • Appetite changes and/or weight loss or weight gain
  • Decreased energy, increased fatigue, or feeling “slowed down”
  • Thoughts of death or suicide, or suicide attempts
  • Difficulty concentrating, remembering, or making decisions
  • Persistent physical symptoms, such as headaches, digestive problems, or chronic pain that do not respond to treatment
  • Constant negativity/pessimism or chronic low self-esteem
  • Persistently dissatisfied or bored

Type 3: Mixed Anxiety / Depression

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

Type 4: Overfocused Anxiety / Depression

Overfocused 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)
  • Specific 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 Overfocused Anxiety/Depression include 4 symptoms of Pure Anxiety and/or Pure Depression (listed above), plus at least 4 of the following:

  • Senseless or excessive worry
  • Upset when things are out of place or things don’t go as planned
  • Tendency to be oppositional or argumentative
  • Prone to have repetitive negative or anxious thoughts
  • Vulnerability to compulsive or addictive behaviors
  • Intense dislike of change
  • Propensity to hold grudges
  • Difficulty seeing options in situations
  • Clinging to own opinion and not listening to that of others
  • Getting upset when things aren’t done a certain way
  • Others complain you worry too much
  • Habitually saying “no” without first thinking about the question

Type 5: Temporal Lobe Anxiety / Depression

Temporal Lobe Anxiety/Depression reflects too little or too much activity in the temporal lobes, which are involved in mood, emotional regulation, 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 of Pure Anxiety and/or Pure Depression (listed above), plus at least 4 of the following:

  • Short fuse or periods of extreme irritability
  • Episodes of rage with little provocation
  • Often misinterpreting comments as negative when they are not
  • Periods of spaciness or confusion
  • Feeling panicked and/or fearful for no specific reason
  • Visual or auditory changes, such as seeing shadows or hearing muffled sounds
  • Frequent moments of déjà vu
  • Sensory 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

Type 6: Cyclic Anxiety / Depression

Cyclic Anxiety/Depression is associated with extremely high activity in the brain’s basal ganglia and/or deep limbic system that fluctuate in intensity. 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 cyclothymia, bipolar disorder, premenstrual tension syndrome, and panic disorder are part of this category because they are episodic and unpredictable.

Common symptoms of Cyclic Anxiety/Depression include 4 symptoms of Pure Anxiety and/or Pure Depression (listed above), 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 risky behavior that is a departure from usual
  • 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, insight, 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 symptoms of Pure Anxiety and/or Pure Depression (listed above), 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 and 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 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 or COVID-19), 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.


“With A Better Brain Comes A Better Life”

– Daniel G. Amen, M.D.


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