Types of Anxiety: Recognizing Different Patterns of Fear

Introduction

Anxiety is not a single experience — it is a broad category of emotional and physical responses that show up in many different forms. Two people can both feel anxious, but express it in completely different ways. One may talk fast and fidget, while another may shut down and go silent. One may avoid situations, while another seeks reassurance repeatedly.

For individuals with developmental disabilities, autism, mental health conditions, or dementia, anxiety can be even more complex. Communication differences, sensory sensitivities, cognitive changes, and past experiences all influence the type of anxiety they feel — and how they show it.

Understanding the type of anxiety someone is experiencing helps caregivers recognize:

• what the person is afraid of

• why the anxiety is happening

• what environmental or internal triggers are involved

• how to respond in a way that restores safety

When we understand why a person is reacting instead of focusing on what they are doing, caregiving becomes more compassionate, effective, and emotionally safe for everyone.

Below are the most common types of anxiety — described in depth with signs, causes, and caregiver examples.

1. Generalized Anxiety Disorder (GAD)

The anxiety that never seems to turn off. Chronic worry about everyday things

Generalized Anxiety Disorder is one of the most common forms of anxiety. It involves persistent worry about everyday events, even when nothing is wrong.

People with GAD often describe their brain as:

• constantly thinking

• expecting the worst

• unable to relax

• feeling tense for no reason

• worrying about many things at once

Common Signs

• chronic overthinking

• need for reassurance

• difficulty sleeping

• muscle tension

• restlessness

• fatigue from mental pressure

• inability to enjoy the present moment

How It Looks in Developmental Disabilities or Dementia

• repeating questions

• asking the same thing every few minutes

• worrying about schedule changes

• needing frequent reassurance: “Are you sure?”

• controlling behaviours to feel safe

Caregiver Example

-A client asks “When are we leaving?” ten times even though the answer never changed.They are not being annoying — their nervous system cannot settle.

-A person repeatedly asks, “Are you sure we’re going today?” even though nothing changed. Their brain keeps imagining what could go wrong.

-Someone cannot relax at home because they keep thinking about future problems: bills, appointments, relationships, work, even small tasks.

-An adult with DD becomes tense and restless every evening because their mind is scanning for “what if” scenarios, even when the routine is predictable.

What Helps

• predictable routines

• visual schedules

• calm, consistent answers

• grounding techniques

• gentle reassurance (“You’re safe. I’m here.”)

  
  

2. Social Anxiety

The fear of being judged, embarrassed, misunderstoodor ,“not good enough.”

Social anxiety is not shyness — it is fear rooted in self-protection.

Many people with social anxiety constantly monitor themselves:

• “Did I say something wrong?”

• “Are they judging me?”

• “What if I embarrass myself?”

This is especially common in teens, young adults with ASD, and adults with past trauma.

Common Signs

• avoiding group activities

• refusing new social environments

• fear of meeting new people

• avoiding eye contact

• speaking very quietly

• blushing, sweating, or fidgeting

• over-apologizing

• masking (acting overly cheerful to hide fear)

In Developmental Disabilities

• hiding behind staff

• refusing to attend community outings

• becoming quiet or frozen when addressed

• leaving social situations abruptly

In Dementia

• withdrawing due to fear of making mistakes or forgetting names

Caregiver Example

-A young adult refuses to enter a classroom, not because they dislike the class, but because they fear being judged by peers.

-Someone refuses to join a group activity because they think others will laugh or talk about them.

-During conversations, a person talks very quietly or avoids eye contact because they feel pressure to say the “right” thing.

-A teen with ASD avoids school events because they are afraid people will look at them, even if no one is paying attention.

What Helps

• slow exposure

• reducing social pressure

• allowing the person to observe first

• validating feelings

• avoiding “Come on, don’t be shy” (this increases shame)

3. Panic Disorder

Sudden intense fear with strong physical symptoms

A panic attack is a powerful burst of the body’s alarm system.It feels physical — like something is seriously wrong.

Symptoms

• chest tightness

• racing heart

• shaking

• dizziness

• difficulty breathing

• fear of dying or losing control

• numbness or tingling

• sudden need to escape

In Developmental Disabilities

Panic often shows as:

• screaming

• bolting

• sudden crying

• hiding

• breath-holding

• trembling

In Dementia

• repeatedly saying “Help me!” or “Something is wrong!”

• clutching the chest

• insisting they can’t breathe

Caregiver Example

-A senior suddenly grabs their chest and says, “I think I’m dying.” Medically they are fine — this is a panic response.

-A person feels a rush of terror, can’t breathe well, and believes they’re having a heart attack — but medical tests show they are physically fine.

-Someone suddenly runs out of a crowded place (mall, bus, grocery store) because their body feels overwhelmed.(related in agoraphobia)

-A senior with dementia clutches their chest and repeatedly says, “Help me!” during a panic episode triggered by confusion.

What Helps

• guiding slow breathing

• grounding

• reducing stimulation

• calm presence (“I’m here. You’re safe.”)

• never telling them “It’s just in your head”

4.Specific Phobias

Intense fear of specific objects or situations.

Phobias can develop from trauma, sensory sensitivities, or associations.Common phobias include:

• dogs

• insects

• elevators

• needles

• crowded spaces

• loud noises

• medical environments

Signs

• immediate fear

• freezing or running away

• crying or shaking

• refusing to participate

• strong avoidance

In Developmental Disabilities

Phobias can become very powerful because:

• the person may not understand the fear

• communication limitations intensify distress

• sensory overload increases panic

Caregiver Example

-A person refuses to enter the van because years ago they felt trapped inside — the body remembers even if the mind doesn’t.

-A client refuses to enter an elevator because years ago they felt stuck, and the memory still triggers fear.

-Someone becomes extremely distressed around dogs, even small friendly ones, because the fear response activates instantly.

-A person with DD panics when getting blood drawn — crying, shaking, or bolting — even though they want to cooperate.

What Helps

• slow desensitization

• predictable exposure

• staying calm

• offering choices

• creating distance from the feared object

5. Separation Anxiety (in Adults)

Fear of losing safety when separated from trusted people.

Adults can experience separation anxiety, especially those with:

• developmental disabilities

• dementia

• trauma history

• attachment difficulties

Signs

• clinging

• panic when staff leave

• calling family repeatedly

• difficulty with transitions

• refusing to be alone

• emotional distress during goodbyes

In Dementia

Often expressed through:

• “Where is my husband?”

• “Don’t leave me.”

• following staff closely

Caregiver Example

-A client becomes distressed when their usual support worker takes a day off. This is not manipulation — it is attachment fear.

-An adult becomes anxious when their usual caregiver is off shift and repeatedly asks, “When are they coming back?”

-A dementia patient follows staff around, afraid of being left alone in a room.

-A spouse becomes distressed when their partner leaves the house, checking the window repeatedly until they return.

What Helps

• consistent staff

• preparing for absences

• transitional objects (photo, note, comfort item)

• gentle reassurance

• predictable routines

  
  

6. Health Anxiety / Somatic Anxiety

Fear focused on body sensations or illness.

People with health anxiety interpret normal sensations as serious disease.

Signs

• constantly checking body

• frequent doctor visits

• obsessively searching symptoms

• believing “something is wrong” despite medical reassurance

In Developmental Disabilities

• complaining about stomach aches, headaches, chest pain

• difficulty understanding how stress affects the body

Caregiver Example

-A client repeatedly says “I think I’m sick” even after multiple checks.

-A person interprets normal sensations (headache, stomach ache) as signs of a serious medical problem.

-Someone checks their pulse or breathing repeatedly throughout the day, worrying something is wrong.

-A client keeps asking to see a doctor even after being medically reassured many times.

What Helps

• grounding techniques

• body-awareness education

• reassurance without over-explaining

• reducing symptom-checking behaviors

7. Obsessive-Compulsive Anxiety (OCD)

Intrusive fears + repetitive behaviours used to feel safe.

OCD is not about neatness — it is about fear.

Obsessions (intrusive thoughts)

• fear of contamination

• fear of harming others

• fear of forgetting something important

• fear something bad will happen

Compulsions (behaviours)

• checking

• washing

• repeating actions

• arranging items

• asking for reassurance

Caregiver Example

-A person checks the lock repeatedly or cannot leave the house unless items are in a specific order.

-Someone arranges objects perfectly or repeats actions in a specific sequence to prevent imagined harm.

-A person repeatedly asks, “Are you sure everything is okay?” even when reassured multiple times.

What Helps

• gentle boundaries

• 
  

  reducing reassurance

• predictable routines

• grounding

• mental health support if needed

  
  

8. Sensory Anxiety (Common in Autism & Dementia)

Fear triggered by overwhelming sensory input.

This type of anxiety is especially common in autism and dementia.

Triggers

• loud noise

• bright lights

• crowds

• multiple conversations

• unpredictable environments

• strong smells

Signs

• meltdowns

• covering ears

• leaving suddenly

• crying or screaming

• shutdown (silent, frozen)

Caregiver Example

-A client becomes upset in a grocery store because the noise, lights, and movement overload their nervous system.

-Bright lights in a hospital or clinic make someone freeze, cry, or shut down.

-A senior becomes agitated during mealtime because too many conversations and sounds make them feel unsafe.

What Helps

• sensory-friendly environments

• noise-cancelling headphones

• sunglasses or hats

• reducing stimulation

• shorter outings

9. Social-Communication Anxiety

Fear of not being understood — or of communicating incorrectly.

Common in:

• ASD

• aphasia

• intellectual disabilities

• dementia

Signs

• avoiding conversation

• shutting down when asked questions

• difficulty expressing needs

• frustration when misunderstood

• relying on familiar staff only

Caregiver Example

-A person avoids speaking not because they are shy, but because they fear making mistakes or not finding the right words.

-A person with dementia becomes frustrated and shuts down when they can’t find the right words.

-Someone avoids phone calls or answering questions because they fear being judged for how they speak.

What Helps

• patient listening

• visual communication tools

• simple language

• encouraging expression without pressure

• building trust through predictable interactions

  
  

Understanding “What If” Thinking in Anxiety Disorders

One of the strongest patterns across many anxiety disorders is “what if” thinking — the mind imagining danger before anything bad has happened. It is a future-focused fear that tries to prepare, protect, and predict. But instead of helping, it overwhelms the nervous system and creates a cycle of worry.

“What if” thoughts can sound like:

• “What if something goes wrong?”

• “What if they’re upset with me?”

• “What if I get sick?”

• “What if I panic again?”

• “What if I can’t handle it?”

These thoughts feel real because the brain treats imagined danger the same way as actual danger. The amygdala — the brain’s alarm system — cannot tell the difference.

But not all anxiety disorders use “what if” in the same way. Each type has its own version:

1.“What If” in Generalized Anxiety Disorder (GAD)

The “what if” focuses on life problems, big and small.

• “What if I disappoint someone?”

• “What if tomorrow goes badly?”

• “What if things don’t turn out right?”

GAD imagines future problems to try to stay prepared — but ends up creating constant worry.

2.“What If” in Panic Disorder

The “what if” is about physical danger or bodily sensations.

• “What if this is a heart attack?”

• “What if I can’t breathe?”

• “What if I faint?”

A normal physical sensation triggers catastrophic interpretations, starting the panic cycle.

A second layer appears after the attack:

• “What if it happens again?”

• “What if I panic in public?”

This leads to avoidance and fear of the next episode.

3.“What If” in Health Anxiety / Somatic Anxiety

The “what if” focuses on illness and symptoms.

• “What if this headache is serious?”

• “What if the doctor missed something?”

• “What if this pain means something dangerous?”

The mind scans the body constantly for signs of threat.

4.“What If” in OCD

OCD begins with intrusive “what ifs” about harm or mistakes.

• “What if I left something on?”

• “What if I cause harm accidentally?”

• “What if something bad happens because of me?”

These thoughts drive compulsive behaviors (checking, repeating, washing).

5.“What If” in Separation Anxiety

The “what if” focuses on losing a sense of safety.

• “What if you don’t come back?”

• “What if something happens while you’re gone?”

The fear is about being left without protection.

6.“What If” in Sensory Anxiety

Not always verbal, but often physical or intuitive.

• “What if it gets too loud?”

• “What if the lights hurt my eyes?”

• “What if the noise becomes overwhelming?”

This is common in autism and dementia.

7.“What If” in Social-Communication Anxiety

Focused on being judged or misunderstood.

• “What if I say something wrong?”

• “What if I embarrass myself?”

• “What if people think badly of me?”

This fear often leads to avoidance or silence.

Why This Matters for Caregivers

Understanding “what if” thinking helps caregivers respond with empathy:

• Instead of seeing someone as “irrational,” you see fear trying to protect them.

• Instead of correcting the thought, you support the person’s nervous system.

• Instead of frustration, you offer safety and grounding.

Every “what if” thought is a message from the brain:

“Please prepare me… please protect me… please keep me safe.”

When caregivers understand the purpose behind “what if” thinking, they can support individuals with patience, compassion, and calm presence.

Closing Reflection

Anxiety takes many shapes, and every type tells a story about what the person is trying to protect. When caregivers can identify these patterns, they respond with empathy instead of judgment — and safety instead of pressure.

Understanding anxiety is not about labeling people.It is about understanding their fear so we can support their needs.

At EmpowerLiving Community Services Society, we believe that every behaviour is communication — and every expression of anxiety is a message:

“Help me feel safe.”

With compassion, routine, and gentle support, individuals can regain stability, confidence, and a sense of control in their daily lives.

Join Our Community

If you or your loved one is looking for a supportive, inclusive day program in the Tri-Cities area, we would love to meet you.

Email: contact@elcss.org

Phone: 604-945-2117

Website: https://www.empowerlivingsociety.org/

Together, we can create a community where every individual — regardless of ability — is empowered to live, learn, and belong.