Is it fear or something worse

Anxiety disorders

For us, fear is a very normal and vital feeling. When does fear become a disorder or a disease? When should someone start looking for help and support? Specialists and therapists speak of an anxiety disorder when fears

  • appear inappropriate and stronger than necessary;
  • occur too often or last too long;
  • when fears are associated with a feeling of loss of control over their occurrence and persistence (that is, the fear "controls" the person);
  • lead to avoiding certain situations without the presence of a real threat; one speaks here of fear of fear;
  • go hand in hand with severe psychological distress.

If fear becomes independent and occurs in actually harmless situations, then it can no longer be controlled and monitored for those affected.


The group of anxiety disorders is the most common mental disorder. Around 10 to 14 percent of the population suffer from an anxiety disorder that requires treatment. One in four will have an anxiety disorder at some point in their life. (...)

Anxiety disorders can also appear as a side effect of other illnesses, e.g. B. in diabetes or cardiovascular diseases. Fears are often related to other mental illnesses. Depressive symptoms in particular often overlap with anxiety disorders. (...)

What anxiety disorders are there?

  • A. phobia is an unjustified fear of objects, e.g. B. spiders, dogs, other people or certain characteristics of a situation, e.g. B. Height, public places, long journeys or public transport. (...)
  • Specific phobias refer mainly to certain objects, such as spiders or snakes. (...)
  • Of Social phobia speak when inappropriate fears and insecurities are associated with social situations. This includes the fear of being the center of attention, embarrassing or humiliating behavior. (...)
  • Of Agoraphobia One speaks when people are afraid of crowds, public places, the use of public transport or car trips. (...) Agoraphobia is often associated with panic disorder.
  • Panic disorder are characterized by spontaneously occurring, recurring, pronounced attacks of anxiety, which are accompanied by intense, physical symptoms such as racing heart, sweating, dizziness, etc. (...)
  • People under a generalized anxiety disorder (GAS) sufferers are constantly in fear that something bad might happen. You brood about everyday things and can't stop worrying all the time. (...)


When we experience fear, the stress and fear system is activated in our body. The whole organism is put on alert. Information reaches our brain via the sensory organs. This information is transmitted in two different ways via an area in the brain called the thalamus. One way is unconscious and very fast, the other way is conscious and much slower.

So to speak, "the fast highway" leads directly to the amygdala. The amygdala, also called the almond kernel, plays an important role in regulating emotions and recognizing danger. It triggers the fear and stress response. If arousal persists, these processes in the brain can play a key role in the development of an anxiety disorder (...)

The slower way of processing leads, so to speak, over the country road. This path includes a conscious processing and assessment of the information from the eye and ear. Depending on the processing and evaluation, a corresponding reaction is triggered in the body.

An override of the fear system can result from various factors. Negative experiences, such as B. early separation experiences in childhood can leave traces. Traumatic experiences in particular have an effect on the fear system. (...) Anxiety disorders very often arise from prolonged stressful and overwhelming situations. Those affected function at a high level of stress. Over time, the feeling of helplessness arises. Those affected develop worries and fears that they will no longer be able to cope with the requirements and that they will not be able to meet their own performance requirements. There is a risk that the anxiety system will remain activated for long periods of time.

Helpful handling

  • Caregivers can relieve and encourage: For fearful people, caregivers in the environment, whom they can trust, are particularly important. When these people offer them help and hope that they are not at the mercy of fear, then this is particularly effective. (...)
  • Pursue specific goals in everyday life: If those affected set goals again in everyday areas of life such as work, living and coping with everyday life, this helps to cope with the fear. You should gradually approach the goals. (...)
  • Don't overwhelm: Those affected should not be overwhelmed (...). For them, stabilization and supportive discussions and offers are in the foreground. (...) Only when they are reasonably psychologically stable can the first steps into avoided and unsettling areas of life be dared.
  • Promote self-efficacy: All measures and support offers that increase and promote self-efficacy are useful. This includes a sense of achievement in the workplace or the successful completion of everyday tasks or leisure activities that have been avoided for a long time. (...)
  • Reduction of safety and avoidance behavior: Security behavior prevents an adequate review of the threat imagination from taking place. (...) Only through real experience is it possible to reduce these everyday fears. (...)

Helping people help themselves

Those affected should use as many opportunities as possible in everyday life to cope with fearful situations. You can proceed step by step, create a scale and begin with simpler situations and slowly dare to approach more difficult ones. But you can also go straight into more difficult situations if the person has the confidence to do so and everyday life requires it. The important thing is that you never stop in the middle of the situation. Experiencing fearful situations increases self-esteem, the experience of self-efficacy and reduces the experience of fear in the situation and the fear of expectation. (...)

The symptoms of anxiety then increasingly affect the entire life of those affected: the ability to work, social relationships, leisure activities, etc. Therefore, one should not wait too long when treating anxiety disorders, they tend to become chronic.

Severe anxiety disorders can also be treated as an inpatient. The inpatient treatment should then lead to outpatient psychotherapy.

Medication can make people feel less anxious, calmer, and tense. Antidepressants are often prescribed in connection with anxiety. For short-term relief and symptom treatment benzodiazepines, i.e. sedatives, e.g. B. Tavor or Valium. (...)

It helps those affected if they are as well informed as possible about anxiety disorders. (...)

Golden rules

  • Always remember that your feelings of fear and the physical symptoms occurring are nothing more than a kind of "exaggeration" of a completely normal body reaction in a stressful situation.
  • Such feelings and body reactions, while uncomfortable, are neither dangerous nor harmful in any way. Nothing worse will happen!
  • If you are afraid, do not exacerbate yourself with thoughts like "What is going to happen?" and "Where can this lead?" into even greater fears.
  • Wait and give the fear time to pass. Don't fight your fear, don't run away, just accept the fear. "It is what it is" can be a helpful attitude.
  • Watch the fear subside on its own as you stop getting further into your thoughts.
  • Remember, the only thing that matters when practicing is learning to deal with fear - not avoiding it. This is the only way to give yourself a chance to make progress.
  • Keep your inner goals in mind and see what progress you have already made. Think how satisfied you will be if you succeed this time too.
  • When you feel better, have a look around and plan the next step.
  • When you feel able to move on, try to move into the next exercise calmly and calmly.


  • Download the S3 guideline on the treatment of anxiety disorders (abridged version) as a PDF file
  • Download the S3 guideline on the treatment of anxiety disorders (patient guideline) as a PDF file
  • Basset, L .; Terwort, N. (2011): Living fearlessly: The successful program against stress and panic. Beltz Verlag, 7th edition.
  • Felten-Leidel, B. (2013): Rabbit heart and chains of worries - My life with fear. BALANCE buch + medien verlag, 2nd edition.
  • Hax-Schoppenhorst, T .; Kusserow, A. (Ed.) (2014): The fear book for nursing and health professions: Practical handbook for nursing and health work. Hogrefe Publishing House.
    [To the book review]
  • Hoyer, J .; Beesdo, K .; Becker, E. S. (2016): Counselor Generalized Anxiety Disorder. Information for those affected and their relatives. Hogrefe Verlag, 2nd edition.
  • Andreas Humbert: The generalized anxiety disorder in the blog "My way out of fear"
  • Institute for Quality and Efficiency in Health Care (IQWiG): Download generalized anxiety disorders as a PDF file
  • Peurifoy, R. Z. (2006): Anxiety, Panic, and Phobias. A self-help program. Verlag Huber, 3rd edition.
  • Robert Koch Institute (2004): Download the issue of anxiety disorders as a PDF file.
  • Schmidt-Traub, S. (2008): Coping with fear. Self-help with panic and agoraphobia. Springer publishing house.
  • Thieda, K. N. (2014): I am by your side. Help for partners of people with fears. Patmos Publishing House.
    [To the book review]