Anxiety Disorders Service | Psychiatry | Dartmouth-Hitchcock
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Anxiety Disorders Service

The Anxiety Disorders Service (ADS) at Dartmouth-Hitchcock is devoted to clinical care, research, and training in the treatment of anxiety and related disorders. We contribute to the advancement of treatments for anxiety and anxiety-related disorders through clinical research, evidence-based practice, and excellence in training of scientist-practitioners in the field.

What are anxiety disorders?

Anxiety disorders are among the most common mental health problems. Common symptoms of anxiety include unrealistic or excessive worry; sleep disturbances; dizziness; jittering, racing or pounding heart; upset stomach; numbness in hands, face or feet; and fatigue. Along with obsessive-compulsive disorder and post-traumatic stress disorder, anxiety disorders will affect nearly 30% of the American population at some point in their lives. The National Institute of Mental Health estimates that more than 40 million people develop an anxiety disorder every year.

Anxiety disorders develop when a person experiences unreasonable and disturbing sensations of fear, worry, and tension in the absence of an apparent cause. Although anxiety is a normal human experience, excessive anxiety may lead to interference in a person's life. Fortunately, there are effective treatments for anxiety disorders. The clinicians at the Anxiety Disorders Service provide state-of-the-art assessment and treatment of anxiety and related disorders.

What problems are treated in the Anxiety Disorders Service?

  • Panic disorder: Fear and apprehension of anxiety attacks that occur for no apparent reason. The individual may feel like he or she is losing control, dying, or going crazy. Physical symptoms include heart palpitations, shortness of breath, sweating, faintness, and sensations of choking or smothering. Agoraphobia may also be present when an individual experiences fear and avoidance of situations from which help or escape is not easily available, such as in a crowd or on a bridge.
  • Specific phobias: An intense fear and avoidance of a particular object or situation, such as snakes, blood, heights, or flying, among many others, leading to a change in usual behavior to avoid encountering the object or situation.
  • Social anxiety: Fear of being evaluated negatively by others or being painfully embarrassed in a social setting. Situations can include speaking, writing or eating in public, being assertive or carrying on a conversation.
  • Generalized anxiety disorder: Chronic, uncontrollable worry about everyday life occurrences and activities, often accompanied by feeling keyed-up and on-edge. Other symptoms include muscle tension, irritability, difficulty sleeping, and fatigue.
  • Obsessive-compulsive disorder: Recurrent, distressing intrusive thoughts that a person appraises as dangerous and that interfere in daily life. Obsessive thoughts, compulsive or repeated behaviors and rituals. Compulsive behaviors may initially relieve anxiety or eliminate obsessive thoughts, but quickly become distressing themselves. Examples include an excessive fear of contamination leading to excessive cleaning or hand washing, repeating a word or phrase over and over again, or checking to confirm that a door is locked, an oven is off or a window is shut.
  • Post-traumatic stress disorder (PTSD): Persistent anxiety that follows a traumatic event, often accompanied by intrusive recollections of the traumatic event, avoidance of reminders of the event, nightmares, poor concentration, sleep problems, and other emotional distress. Although most people think of war veterans when they think of this disorder, anyone who has survived a significant mental or physical trauma (e.g., a car accident or sexual or physical assault) can develop PTSD.

Do you treat other problems in the Anxiety Disorders Service?

There are a number of disorders that are related to anxiety that are treated in the Anxiety Disorders Service. These include:

  • Hoarding disorder: Difficulty and distress that occurs when an individual is faced with the task or challenge of discarding or otherwise parting with objects. This includes objects that others perceive as being of little monetary or other value. Hoarding may result in family conflicts, home maintenance problems, or eviction from a residence. The difficulty discarding may also be accompanied by seemingly irresistible urges to acquire additional unneeded objects.
  • Health anxiety (Hypochondriasis): Fear and worry about the possibility that an individual has an undiagnosed or undetected physical illness. The individual experiences excessive anxiety about health status, and may engage in repeated checking of health status (e.g., searching the Internet for health information) or frequent visits to their doctor, or alternatively, may avoid all healthcare services and reminders of health.
  • Trichotillomania (hair-pulling disorder): Repeated pulling of one's own hair, often resulting in hair loss and emotional distress. Individuals with Trichotillomania may be unaware of the behavior in the moment, and may occur more frequently during times of boredom or tension, or during stressful life events.

How is anxiety treated?

Effective treatments for anxiety disorders fall into two general types: cognitive-behavioral therapy (CBT), and medication.

Cognitive-based therapy (CBT)

Cognitive-based therapy (CBT) encompasses a set of therapeutic techniques that address the cognitive (thinking) and behavioral (action) components of anxiety. Cognitive techniques help individuals learn to recognize thoughts and beliefs that trigger anxiety and learn new ways to deal with them. Behavioral techniques help the individual learn to change behavior patterns that maintain anxiety and to react to stressors in more effective ways. Cognitive and behavioral techniques complement one another and are typically used simultaneously. Ideally, addressing one component can lead to changes in both. Our service specializes in the use of exposure therapy for anxiety and related disorders, which have been shown to have the greatest effect for problems.


Medication may also alleviate the distressful and disruptive symptoms of anxiety disorders, and is most effective when used in combination with cognitive-behavioral therapy.

If you think you have an anxiety disorder…

Anxiety disorders can be effectively treated. There is no reason to suffer in silence. Contact us for help. Clinicians in the Anxiety Disorders Service offer confidential assessments of anxiety-related problems. During the initial diagnostic evaluation, an ADS clinician will inquire into your symptoms, how long they have been occurring, and the level of distress they cause you. The clinician will gather information about your physical health and family history of anxiety-related problems. The clinician will also consider the possibility of co-occurring problems, such as depression and/or substance abuse.

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