Anxiety and Anxiety Disorders (Overview)
Anxiety can be experienced at any stage of life, it may start in childhood or teenage years and continue into adulthood. It can also be as a direct result of a concerning medical condition that requires treatment.
Anxiety is a psychological, physiological, and behavioural state that may be exhibited in people due to an actual or perceived threat to well-being or survival. Anxiety is characterised by an increase in arousal, expectancy, autonomic and neuroendocrine activation, which results in specific behavioural patterns. These changes in physical and mental states enable the person to cope with adverse or unexpected situations.
Therefore, feelings of fear and apprehension are a natural response to stress and situational triggers. Occasional anxiety about the first day of school, going to a job interview or new place of work, hosting an event, or giving a speech or presentation is a common, often natural response to feeling nervous or a little fearful.
If you experience such feelings in such a way that they are consistently part of your life for longer than 6 months and are interfering with your ability to lead a normal lifestyle, this may mean that your anxiety has escalated to an anxiety disorder. An anxiety disorder is considered a serious mental illness.
An anxiety disorder is typically characterised by frequently intense, excessive or persistent worries and fears about everyday situations. Repeat episodes of sudden or intense feelings (overwhelming) can peak within minutes and cause terror or panic (bringing on panic attacks).
Intensity of fear and worry can be difficult to control, especially if out of proportion to an actual danger, or if lasting for a long time. A person may try and counteract these types of feelings by actively avoiding places and situations.
Some anxiety disorders include generalised anxiety disorder (GAD), social anxiety disorder (or social phobia) and separation anxiety disorder. It is possible to be diagnosed with more than one anxiety disorder.
An anxiety disorder can be disabling, but is manageable. With careful treatment, a person suffering anxiety can get back to and lead a fulfilling life.
What to expect
Anxiety disorders are the most common of the emotional disorders and can affect anyone at any age of their life. Anxiety, very often, links with depression, substance abuse (alcohol and drugs) and addictions. These dependent behaviours ultimately make the condition worse, but in the short term ‘feel’ like they are providing temporary relief.
In some cases medical professionals find it necessary to treat an alcohol or drug problem before even addressing the anxiety disorder as a way of getting all under control in the long term.
What does anxiety feel like? Anxiety is different in different individuals. One person may liken the ‘feeling’ to standing in the middle of building that is crumbling or falling apart without anything to protect yourself with. Another may describe the feeling as if they are standing on a merry-go-round which is spinning at a fast speed and feeling unable to slow it down or stop the motion.
Common descriptions of anxiety include the sensation of butterflies in your stomach or a racing heartbeat. Individuals experiencing anxiety often have nightmares, moments of panic (or panic attacks) or painful thoughts or memories that feel out of their control. The feeling of fear can be general or relate to something specific – a place, a person (or personality type) or even an event.
Symptoms typical of general anxiety are:
- An increased heart rate or heart palpitations
- Rapid / fast-paced breathing (hyperventilation)
- Restlessness (not being able to be still and calm)
- Problems with concentration
- Sleep difficulties (falling asleep)
- Nervousness and tension (especially muscle tension)
- Having a sense of impending doom, danger or panic
- Sweating (especially in the hands and feet)
- Numbness and tingling in the hands and feet
- Fatigue and feeling physically weak
- Gastrointestinal problems
- Difficulties with managing and controlling fears and worries
- Experiencing an urge to avoid things that trigger anxiety
Types of anxiety
Anxiety disorders can be categorised as any of the following types:
- Agoraphobia: A person will experience an intense fear and react by avoiding situations or places that might cause feelings of panic helplessness, embarrassment or a sense of being trapped.
- Anxiety disorder due to a medical condition: This involves feelings of intense anxiety or panic directly as a result of a medically diagnosed condition or illness.
- Substance-induced anxiety disorder: Intense anxiety or panic can occur as a direct result of substance abuse, taking medications or being exposed to a toxic substance. Anxiety experienced with withdrawal from a substance is also common.
- Generalised anxiety disorder (GAD): Persistent and excessive worry that is often unprovoked, about ordinary, routine issues, activities and events. Anxiety of this nature is generally out of proportion (unrealistic) to an actual circumstance, is difficult to control and affects how you feel physically. GAD is often diagnosed with other anxiety disorders or depression.
- Panic disorder: This disorder involves anxiety, fear or terror that generally occurs in repeated episodes of sudden intensity (with little or no warning at all). A strong sense of impending doom, shortness of breath, chest pain, a choking sensation and heart palpitations are commonly experienced. Often panic attacks are likened to a sense of having a heart attack or a feeling that one is “going crazy”. Panic attacks can lead to more worry and anxiety about them re-occuring. This may lead to a person taking steps to avoid situations in which a panic attack has previously occurred.
- Selective mutism: This commonly affects children who express their anxiety by displaying consistent failure to speak in specific situations. This can occur in the home with close family or within a school or social environment.
- Separation anxiety disorder: Often a childhood disorder, anxiety becomes excessive for a child’s developmental level and results in difficulties with separating from parents or others who have parental roles.
- Social anxiety disorder (social phobia): High levels of anxiety, fear and potential embarrassment can lead to avoidance of social situations and self-consciousness. A fear of being viewed negatively, ridiculed or judged by others is typical of someone suffering this disorder type.
- Specific phobias: These are characterised by major anxiety that occurs when exposed to a specific object or situation (such as flying or heights). A sufferer has an intense desire to avoid it and generally experiences an inappropriate level of fear to the situation or object. The fear can reach a tipping point at times can cause a panic attack.
- Hypochondriasis (also known as hypochondria): Intense anxiety about one’s health.
- Post-traumatic stress disorder: Intense anxiety following a highly traumatic event.
- Other specified anxiety disorders and unspecified anxiety disorders: When an anxiety or phobia doesn’t meet any exact criteria for any other disorder type, it will fall into this category. The level of anxiety, though, will be significant enough that it is distressing and disruptive to a person’s lifestyle.
Causes of anxiety
Exact causes of anxiety aren’t fully understood, but like with all illnesses and conditions, there are common denominators. Life experiences, such as traumatic events, can trigger anxiety disorders, especially if they are already prone to the condition. Inherited traits are another commonly noted factor.
Underlying health issues can bring on varying levels of anxiety. Sometimes signs and symptoms of an illness can be the driving force that indicates a physical problem and prompts a check-up that results in a diagnosis.
Medical problems commonly linked to anxiety include:
- Cardiovascular disease (heart disease)
- Hyperthyroidism and other thyroid problems
- Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma
- Chronic pain
- Irritable bowel syndrome
- Rare tumours (particularly those that produce “fight or flight” hormones)
As with any other brain-related illness, anxiety disorders are triggered by problems in the functioning of the brain circuits which regulate emotions such as fear. Severe or long-lasting stress changes the way nerve cells within these circuits transmit information within the brain (from one region to another).
Changes in certain brain structures which control memories, especially when linked with strong emotions, can also trigger anxiety disorders. Anxiety disorders can run in families, and it’s commonly noted that these can be inherited from one or both parents, in a similar way to any other genetic condition (for instance a genetic risk for heart disease or cancer).
Particularly those with an inherited susceptibility to an anxiety disorder, environmental factors (a trauma or significant event) can trigger the illness.
Risk factors and complications
Common factors that significantly contribute to an anxiety disorder are:
- Trauma: This can be because of abuse, a first-hand traumatic experience or a witnessed traumatic event. Trauma-related causes may occur at any point in a person’s life, from as early as childhood.
- Stress related to an illness, build-up to a big event or life situation such as work, ongoing worry (for example with finances) or death in the family.
- Other mental health disorders
- Blood relatives with a diagnosed anxiety disorder
- Substance abuse or withdrawal (drugs and alcohol)
An anxiety disorder can cross boundaries and if not treated effectively, may sometimes result in a worsened condition or lead to other mental and physical problems. These can include depression, substance abuse, insomnia, digestive or bowel problems, chronic pain, headaches, social isolation, poor quality of life, a total inability to function at school or work, and suicide.
When should you see a doctor?
It is time to seek help when:
- You feel like your constant worrying is beginning to interfere with your career / work, relationships and overall lifestyle.
- You find that you are unable to control your feelings of fear and worry and your anxiety is troubling you. Your worries don’t go away on their own and you find that your anxiety worsens over time.
- You frequently use alcohol or drugs or have other mental health problems.
- You are concerned that your anxiety may be linked to a physical health problem or illness.
- You experience depression and or / have any suicidal thoughts or behaviours. If this occurs, it is strongly advised to seek immediate help from a medical professional.
A doctor (Primary healthcare provider) or mental health provider (psychologist or psychiatrist) can get anxiety under control, so it is a good idea to seek help before things escalate and become worse. It is much easier to treat if you seek help early.
Diagnosis and tests
Once at your consultation your doctor (or mental health professional) will begin an evaluation by asking various questions about your symptoms and your overall medical history. He or she will then conduct a physical exam (assessing your blood pressure, heart rate, respiration rate, temperature, general appearance, as well as check your head, neck, abdomen, nerves, muscle strength, reflexes, balance, skin and nails and other physical and sensory changes).
No laboratory tests are used to diagnose an anxiety disorder. Tests will only really be used if your doctor (GP or general practitioner) feels it necessary to check for other medical illnesses causing the anxiety symptoms.
A GP will then refer you to a psychiatrist (a medical doctor who specialises in diagnosing and treating mental health conditions) or psychologist (a specialist in diagnosing and providing therapy or counselling for mental health conditions) following an initial assessment and physical exam. Psychiatrists and psychologists will then use a specially designed interview (assessment) during your consultation, along with any other assessment tools to evaluate the probability of an anxiety disorder, and if so, what type.
Your psychological assessment or evaluation will involve describing your thoughts, feelings and behaviour. Other assessment tools may involve a DSM-5 (diagnostic and statistical manual of mental disorders) to assist with the diagnosis process by comparing symptoms and your interview assessment.
A diagnosis is based on the report which follows this assessment and covers the intensity of the anxiety, duration of the symptoms (including problems with daily functioning caused by the symptoms), and the doctor’s observations of attitude and behaviour during the consultation. The degree of dysfunction will assist the specialist with determining a specific anxiety disorder.
Treatments and medications
Treatment typically takes on two forms – psychotherapy and medications. Many benefit from a combination of the two, but it can take a little trial and error to find the plan that will best work for you. Other things that work well in combination with therapy and medications are dietary and lifestyle changes, as well as relaxation therapy.
- Psychotherapy: “Talk therapy” or psychological counselling involves working with a therapist to reduce symptoms of anxiety. Most mental health professionals recommend cognitive behavioural therapy (CBT) which can be a very effective treatment for anxiety. CBT focusses on teaching you how to improve your symptoms with specific skills, which assist in gradually enabling you to return to normal activities and behavioural patterns. CBT includes exposure therapy which gradually introduces encounters with objects and situational triggers as a way to build confidence in better managing reactions. This may sound incredibly scary if you have an anxiety disorder, but it is done in a responsible, caring way that will assist you overcoming your fears.
- Medications: There are several types that may be recommended to alleviate symptoms, and depending on the type of disorder you are diagnosed with. Medication treatment will also depend on other mental or physical health issues you may be experiencing. Anti-depressants or anti-anxiety medications are effective drug treatments. In limited circumstances a doctor may prescribe a type of sedative for short-term relief of anxiety symptoms. Other medications include anticonvulsant and low-dose antipsychotics. As with any medication, there are benefits, risks and side-effects of using these drugs. You should work very closely with your doctor in taking medications and managing the dosages for effective relief.
Living with and managing anxiety
Lifestyle changes can also make a difference and should be encouraged as part of any treatment plan. Things you can do to keep your anxiety under control are:
- Keep physically active: A routine that allows you to be physically active most days of the week can do wonders with controlling anxiety. Exercise is a powerful stress reliever. Exercise helps to improve mood and keep you physically healthy. Choose an activity that you enjoy, start slowly and gradually build up the amount of times you participate in it and the intensity for maximum benefit.
- Avoid alcohol and recreational drugs: Substances that worsen anxiety symptoms should be avoided altogether. If you cannot stop on your own, find a support group or health professional that can help you as soon as possible.
- Cut back or quit smoking, and drinking caffeinated beverages: Stimulants like nicotine and caffeine can worsen symptoms of anxiety.
- Relaxation and stress management: Meditation and visualisation techniques are great relaxation exercises you can use to ease your anxiety.
- Get plenty of rest: Do all you can to make sleep a priority (and get enough of it). Feeling rested helps you function and alleviates other emotions which trigger your anxiety. If you have trouble sleeping, it is a good idea to see your doctor for assistance.
- Watch your diet: Healthy eating and a diet rich in vegetables, fruits, whole grains and fish have been linked in reducing anxiety. A healthy diet will also keep other physical conditions at bay.
- Learn to cope with your disorder: Talk to your doctor or mental health provider and learn about the causes of your disorder and what triggers your stress levels. This will help with practicing the coping strategies developed for you. You can also involve your friends and family as a way of helping them learn how best to understand your condition and how they can contribute to beneficial support. A journal can also be a helpful coping measure, and tool to understand your disorder and triggers.
- Stick to your treatment plan: Keep your therapy appointments, take your medications as required or directed and complete assignments your therapist may give you. Consistency will only help your treatment process.
- Seek out support: You aren’t alone in the symptoms you experience. There are anxiety support groups you can join which offer compassion, understanding and the opportunity to share experiences.
Is anxiety common?
Anxiety is one of the most common of all the mental health conditions. Research indicates that anxiety is commonly diagnosed in 1 in every 4 adults at some point during their lifetime, and up to 1 in ten people will experience some form of anxiety disorder every year.
How long does it take to treat anxiety?
Professional care can help anyone suffering from anxiety. Success of treatment does tend to vary from person to person. Benefits of CBT are usually seen within 12 to 16 weeks. Medication treatment depends on the severity of symptoms and as such, may be short-term or long-term.
Treatment may be complicated if other conditions also require management / treatment, so it often takes time and patience to find a comfortable combination that best works for you. Treatment will always be tailored for your specific needs.