There are many things in life that we are afraid of, or at least have an appreciation for, and a suitable amount of anxiety is an emotion that helps keep us and the ones we love out of harm’s way.
Anxiety keeps the majority of us from protruding at a beehive with a stick, reckless driving, or touching a hot stove. It causes us to get up in the middle of the night to check on the crying baby, to describe bicycle safety to our children, and to caution our teenagers about drinking behind the wheels. Anxiety prompts us to call the cops when we hear a thief outside the bedroom window in the middle of the night.
Anxiety also usually creeps up in situations that aren’t necessarily a danger to life but are different, uncertain, or seen as potentially menacing to relationships, income, social life, or just about any other desire or goal. On the bright side, anxiety urges us to complete our work assignments, conform to the law, show up for work, and pay our taxes. It also contributes to sweaty palms during a job interview, on a first date, during a presentation, sing a tune, or simply introduce ourselves. The rush that occurs during these times may promote a little burst of energy or alertness that improves our performance—but it can also provoke a wave of nervousness that weakens our efforts.
For a few of us, anxiety isn’t restricted to these ordinary occurrences but instead becomes a never ending and arrogant companion. It can ruin relationships, work, and school. It can intervene with sleep. It can provoke binge eating and obesity, loss of appetite, or a full-blown eating disorder such as bulimia. Anxiety can drive habits and traditions that are literally disabling. It can provoke a person to look for relief by attempting to self-medicate, especially with liquor, prescription medications, or even illicit drugs, in a deluded effort to find temporarily relief. In some cases, episodes of severe anxiety referred to as panic attacks appear suddenly and without warning, taking off like a flying jet that literally puts all other activities on hold until the panic attack ends. When a person has anxiety that is continuous, disturbing, and out of proportion to the actual threats of everyday life, that person is said to have an anxiety disorder.
According to the National Institute of Mental Health (NIMH), approximately 18 million Americans adults have an anxiety disorder. There are different types and some variability in the way each of the different disorders shows itself. At the same time, the symptoms of the miscellaneous anxiety disorders may overlap. In other words, they don’t always fit into neat categories, and it’s not out of the ordinary for a person to experience features of more than one type of anxiety disorder. In addition, there is a strong powerful connection between emotions and physical events throughout the body. Because physiological responses normally follow anxiety, physical symptoms are extremely popular in anxiety disorders as well. Indeed, they are often what bring people with this problem to the doctor’s office. Some of these include:
- Heart palpitations. This feeling is often accompanied by a racing heartbeat.
- Shortness of breath. Often the person with these symptoms from anxiety complains that they can’t get enough air. The complaint is for the most part, more noticeable at rest than during exercise. This is nothing comparable to the shortness of breath one experiences from asthma where air flow is damaged both entering and leaving the lung, or by coronary artery disease or congestive heart failure, where shortness of breath occur with very little activity.
- Pain or other distress in the chest. This symptom, along with the others just mentioned, brings up immediate concerns about serious and critical problems in the heart or lungs. Often, it will be required to rule out one or more of these problems, even when the doctor suspects that anxiety may be to blame.
- Aches and pain. Migraines, pain in the neck, or muscle tension around the head, neck, or upper back is often affected by anxiety.
- Tension in the neck. This feeling often times resembles a “lump in the throat” that will not go away. This is called Globus syndrome and may take place in people who do not feel specifically stressed or anxious. Surely, other medical problems are ruled out before this analysis is made.
- An array of intestinal discomfort. These discomforts include loss of appetite, nausea, feeling the need to vomit, pain in the abdomen, and diarrhea. Some of these overlap with a typical physiological disorder known as irritable bowel syndrome (IBS). As with the other syndromes mentioned above, a medical assessment is in order before any of these can be classified as a side effect of anxiety. This is especially important if fever begins or if blood is seen in one or more bowel movement, because neither of these are a result of anxiety.
- Trouble falling or staying asleep (Insomnia).
- Irregular menstruation and pain.
- Aches and pains from other medical problems such as arthritis or chronic pain.
As you will examine shortly, not only do anxiety and depression often times occur together, but many of these symptoms also happen to those who are also depressed.
Some of the more familiar types of anxiety disorders include:
Generalized anxiety disorder (GAD)
This type of anxiety affects roughly 5 million American adults. As the name advocates, anxiety is a continuous companion for these people. People who have GAD are worried every day, day and night, just about everything; health, family, job security, state of the population, the outcome of the world, or simply getting through the day. Sometimes, they don’t know what exactly is causing them to be so worried. They often times have difficulty staying relaxed, concentrate, or falling asleep. Although they may understand that their urgent circumstances don’t permit the constant anxiety, they cannot shake it off or snap out of the fear. GAD progress slowly and can appear at any stage in life, including childhood, and by definition last longer than six months. Depression often escorts this problem.
People with GAD often feel many of the physical symptoms that are listed above, which in turn cause more anxiety. These symptoms may cause frequent visits to the physician’s office, where a careful assessment and multiple tests may be needed to confirm that symptoms are not a result of a serious disease. Many times, the doctor will pick up on clues, provide the necessary medical comfort, and then carefully bring up the subject of an anxiety problem and the possibility of treatment. Sadly, the doctor’s visits may lead to a less rewarding outcome, especially if the doctor is saying that “There is nothing wrong with you. It’s all in your head,” a conclusion that leaves a person feeling no less anxious, and embarrassed as well.
Obsessive compulsive disorder (OCD)
OCD weighs heavily on a person with a sequence of invasive and discouraging thoughts or mental images (the obsessions) and a fascinating need to carry out certain habits (the compulsions). The frequent thoughts may target on primal concerns—safety, health, cleanliness, sexuality, spirituality—or more confusing issues, such as numbers, colors, or the adjustment of items on a kitchen counter. These obsessive thoughts can be equivalent to a giant boom box playing disturbing or startling programs inside of the head throughout the day. The anxiety these thoughts brings about is temporarily relaxed by ritualistic behaviors such as washing hands over and over, checking many times to make sure that the door was locked, counting all types of confusing items, lining up towels or food in the pantry very specifically, and other bizarre behaviors. People with OCD many times realize that their rituals are bizarre and they acquire no pleasure from them.
4 million Americans are affected by OCD, and it usually start during childhood, the teenage years, or early adulthood. One in three people with OCD can remember symptoms beginning in childhood. Symptoms can increase or decrease over time and may reach a point where they fully disturb life at home, school, or work. Counseling may be conductive—mainly to clarify the nature of the problem and learning coping skills—but OCD usually recovers dramatically with medications in the generally used selective serotonin reuptake inhibitor (SSRI) class. When one of these take effect, someone with OCD often characterize the mental “boom box” diminishing way into the background, where the noise from it can be ignored or brushed off. It is commonly accepted that a mixture of prescription medications and counseling produce the most effective treatment of OCD.
This disorder is marked by frequent, erratic episodes known as panic attacks. If you are fortunate enough to not have those, you may not acknowledge how distressing and unsettling they can be. You might see anxiety as the feeling you get when you see red and blue light from a patrol car flashing in your rearview mirror and realize that they they’re meant for you. As you pull over the side of the road, your hart might speed up a little and you neck muscles might be a little tense as you wonder why you are being pulled over. Compare that to a panic attack, this response would be a stroll in the park.
People with panic attack will all of a sudden get a serious and terrifying sense that they are doomed, that death is close. They may feel shaken up, almost as if by electricity or by some other even that is emotionally horrifying, but the sensation lingers. Powerful floods of adrenaline usually kicks in, so the heart pounds, the chest tightens up, and air seems to escape the lungs, never to come back. Most of these symptoms spike in about ten minutes, but some can last longer. The first panic attack—and generally the second or even third—most often times lands someone experiencing it in the emergency room.
Panic attacks are well known for happening out of left field when they are least expected—i.e. driving to work or walking to the grocery store. Some people will only have one episode of panic attack in their lifetime. Most who have felt a panic attack will tend to dodge the place where the episode occurred. The emotions are that extreme. If the attack occurred at work, in the car, or another location where one normally need to go, the result can be very unsettling to everyday life. If the panic attack is not treated and occurs over and over again, that person may start to feel that no place other than the home is safe, which in turn leads to a fear of leaving the house. This is known as agoraphobia and it can literally keep someone trapped in their house.
Around two and a half million American adults have panic disorders, and 60% of these individuals are women. Many also have symptoms of depression or other anxiety-related syndromes. As with obsessive compulsive disorder, counseling can help clear up the nature of the problem and determine coping strategies, but reasonable use of medication is often times needed to curb the problem. Commonly, a short-acting anxiolytic (anxiety reducing) prescription medication such as Xanax is recommended for use at the start of a panic attack in order to end it or at least decrease its severity. This is crucial to bring back a sense of control and prevent the helpless feeling of being on a runaway train, which is frightening during one of these episodes. All in all, a medication that helps conduct neurotransmitters levels is made known as a maintenance agent to prevent further episodes or reduce its severity.
Post-traumatic stress disorder (PTSD)
PTSD Involves a constellation of disabling symptoms that arise after a traumatic event that is perceived as terrifying and life threatening to self or others. Situations that give rise to PTSD include a direct experience of:
- Personal assault, such as mugging, rape, torture, rape, or kidnapping
- A serious automobile, train, plane, or other type of accident
- A natural disaster, such as an earthquake, flood or tornado
- Exposure to combat, especially when seeing others maimed or killed
PTSD can also occur after a traumatic, life-threatening (or fatal) event in the life of a loved one, or after viewing a catastrophe such as a wreck or the victim of a violent death.
Symptoms of PTSD include:
- Re-experiencing the vent through intrusive memories, dreams, or powerful flashbacks. The latter may be triggered by sights, sounds, or even smells that cause a person to relive a traumatic experience.
- Emotional “numbing” or unresponsiveness to others, including those with whom a person was previously close.
- Some PTSD victims become hyper vigilant and can startle easily.
It is important to note that one’s perception of an event plays an important role in determining whether PTSD will develop. Someone who survives a horrendous train wreck and then concludes that “it simply wasn’t my time to go” may not experience any symptoms. But another person involved in a minor fender bender may experience that event as near calamity and become convinced that “this world is a dangerous place, and I’m not safe anywhere, at any time.” This individual is more likely to develop symptoms of PTSD. Research on this phenomenon is also focusing on biological events within the brain that seem to perpetuate powerful reactions to traumatic events rather than allowing the person’s physical and emotional responses to subside.
Over 5 million adult Americans are affected by PTSD. In order to be diagnosed with it, a person must experience a combination of the defining symptoms for at least a month. They typically begin within three months of the traumatic incident (although some surface many months or even years later) and may last for months or even years, often accompanied by depression, irritability, other anxiety disorders, and substance abuse. A variety of treatment approaches are used to help people manage and recover from PTSD.
Social anxiety disorder (also called social phobia)
This disorder creates an extreme and disabling level of anxiety in social situations. A specific situation, such as giving a presentation, interacting with others at school or work, or even attending a party, can provoke trembling, nausea, blushing, difficulty speaking, or other unpleasant reactions. More than 5 million Americans are affected (men and women equally so), and not surprisingly, these individuals may also suffer from depression and other anxiety disorders. They often use alcohol and other drugs as self-medication to better tolerate social situations.
Specific phobias are intense and irrational fears of a particular thing or place, or situation that does not represent a genuine, immediate threat or provoke similar response in most people. Most of us have heard (or know) someone who has claustrophobia (fear of closed spaces), acrophobia (fear of heights), or aviophobia (fear of flying). Of course, it isn’t unusual to be a little edgy when looking over the edge of a cliff or roaring down the runway in a jetliner. Most of us aren’t crazy about snakes and spiders, but few of us have full blown ophiophobia (fear of snakes) or arachnophobia (fear of spiders). A person with phobia reacts with very severe anxiety or even full-blown panic episodes in the presence of the thing feared, and will often go to extreme lengths to avoid it.
Phobias affect more than 6 million Americans and are twice as common in women as in men. Dozens of specific phobias have been identified, many of which provide a rich source of material for word buffs and quiz shows but are no laughing matter to those affected by them.
Researchers now believe that a combination of genetics and a malfunction of structures deep in the brain that regulates our responses to threats are the setup of phobias, but it still isn’t clear how specific objects or situations trigger extreme reactions. If avoiding the object of the phobia isn’t possible, specific types of therapies and desensitization process can help a person prevent or at least tone down the response. The usual treatment involves approaching the federal object or experience first from afar, and then over time increasing exposure gradually enough to avoid an anxiety response, until eventually it provokes little or no reaction.