Disclaimer: this information is not intended for diagnostic purposes. This is intended for educational purposes only. Consult a physician or mental health professional for diagnosis and treatment
In my last blog post, I talked about the difference between fear and anxiety, as well as coping skills for both. Since anxiety is such a huge topic with various pieces to it, I decided to turn it into a two part blog. You can read part 1 here: http://fear-vs-anxiety-part-1-the-difference-between-them-and-coping-skills-for-both
Anxiety. It’s such a common word. We hear it everywhere. From research articles, blog posts, news articles, daytime TV shows, to hearing it from friends and family, church services, etc. It’s a word that is used by a wide range of people. When I hear the word “anxiety” people are typically using it to refer to a sense of worry and fear. This is correct. Anxiety is a sense of worry and fear that is associated with future events. But what people typically do not mention is that anxiety has physical, mental, emotional, and behavioral symptoms.
Physical symptoms can include: Nervousness, restlessness, accelerated heart rate, sweating, abdominal distress, hyper alertness, inability to relax, etc.
Mental symptoms can include: lack of concentration, racing thoughts, impending doom, thinking about the worst possible outcome, dread, thinking you should be better or better at handling something, etc.
Emotional symptoms can include: sadness, fear, nervousness, hopelessness, helplessness, irritability etc.
Behavioral symptoms can include: pacing, clicking a pen, talking fast, stumbling over words, jittery or jerky movements, being startled easily, etc.
Why is there the same symptoms in more than one area? I’m glad you asked! All emotional states, including anxiety, are multifaceted. This means that even though we typically notice something as either emotional or mental distress, emotional states actually encompass the body physically, mentally, emotionally, and behaviorally. They are all intertwined. According to a popular counseling model, Cognitive-Behavioral Therapy, thoughts lead to emotions, which lead to behaviors. This is a huge implication for normal anxiety and anxiety disorders.
Yes, you heard me right. There is such a thing as normal anxiety. It is a normal emotion that we all experience, same as happiness, sadness, and anger. The reason anxiety is typically referred to as a “negative” emotion is because of the emotional consequences of it. For example, we get nervous about something that is unpredictable and, therefore, get nervous about not knowing what might happen. There is an element of unpredictability and helplessness within anxiety. We either feel we cannot predict what will happen or we feel we cannot control the outcome.
Some typical examples of normal anxiety include: giving a presentation, going on an interview, talking to your partner about something serious, and taking exam’s in school. Anxiety, in these situations, serves partially as a messenger–telling you what it is you are worried about, how you want something to go, and potential things that may go wrong with the situation. It also serves as a motivator. If we feel anxiety about something, we may be more inclined to prepare for it. Yes, in these instances, anxiety is a good thing.
How does anxiety turn into a disorder? That’s a complicated answer. And truthfully, I don’t think we fully know the cause of it. More research is needed at the etiology of anxiety (when is more research not needed?). But currently, it appears to be that anxiety disorders can be a combination of nature and nurture. Nature is what we are born with, genetics. Nurture is our experiences growing up. The combination of the two equals who we present as today. So, let’s look at an example of these two!
Anxiety genetics are a thing and we can get them from parents. If our parents. or anyone in our blood relatives for that matter, have been diagnosed with an anxiety disorder or have anxiety related issues (finding a qualified professional to diagnose can be difficult, especially for poverty populations), we are at an increased risk for having an anxiety disorder. Sometimes, whether our blood family has anxiety disorders or not, we can be diagnosed with one as we grow up. This is part of the nurture aspect, where our experiences create who we are. For individuals who have been through situations that resulted in feelings of hopelessness, helplessness, shame, depression, grief, or any other type of feeling or situation related, anxiety can be a consequence. Anxiety is a consequence when we have dealt with traumatic or unexpected circumstances and we feel we cannot control the outcome. Therefore, anxiety disorders can result.
Now that we have covered that part of anxiety, we can cover the difference between normal anxiety and anxiety disorders. Any type of mental health issue is considered to be normal states and/or trait’s, but with the “volume turned up” which often creates issues socially, academically, job performance, and other areas of life. (This is why we can read any disorder in the DSM-5 and recognize these symptoms in ourselves). Normal anxiety is typically situation and does not cause too much problems for the person. They can make it through their presentation, job interview, social situation, and other related circumstances without too much problems. Anxiety disorders, on the other hand, are a frequent concern and frequently cause issues for the person. But even with this simple definition, nailing down anxiety disorders can be difficult.
Anxiety disorders can present in many different ways. Some people have excess worry that prevents them from good performance on a regular basis. This can be situational, such as having to meet with your boss on a regular basis and feeling like you cannot effectively engage in a conversation with them. Anxiety is a common complaint in these types of situations, though I would argue that in this situation the anxiety is trying to tell you that change is needed. Typically, when I have client’s that present with obvious anxiety disorders, they present with complains about the physical effects and emotional effects of anxiety.
If anxiety lasts for a substantial amount of time, our brain chemicals can be altered, just like it does in depression. This can result in our brain’s continually firing off “warning” signals of potential upcoming or imminent danger/threat, resulting in the feeling of nervousness, jittery or jumpy movements, and other emotional consequences even if there is no actual threat. This is a built in system in our bodies that prepare us for fight, flight, or freeze. But this system can become “broken,” which is why a lot of people with anxiety disorders complain of having anxiety “for no reason” and “even when I’m alone at my house.” The feeling lingers, even after the threat is gone. If this state lingers long enough, anxiety can be a real, constant threat. The nervousness and jittery feeling can result in stumbling over words, losing your train of thought, saying something you wish you wouldn’t have, and even panicking on a daily, and regular, basis. Typically, people will say their anxiety waxes and wanes, but the threat of anxiety preventing them from engaging in situations they would like to do a good job in is ever present.
This “broken system” is why a lot of people turn to medication to relieve anxiety. Medications such as the popular Xanax, Klonopin, and Valium, physically trigger our parasympathetic nervous system, which is responsible for rest. This forces the body to go into rest mode, even if the mind has not perceived an end to the threat. This is also why these medications are highly addictive. Not only do they pose a threat for tolerance, but the mind and body are not working in conjunction with each other. The brain is activating the sympathetic nervous system–fight or flight mode. While the medication is simultaneously activating the parasympathetic nervous system. The result: your body is confused and you are treating symptoms, not the underlying cause. In order to treat anxiety disorders, it is best to do things that intervene in the firing off of the brain chemicals that contribute to fight or flight. Tell yourself you’re safe, you have this under control, do breathing exercises, progressive muscle relaxation, meditation, visualization, literally anything that is calming. Over time, these practices not only activate the calming system in your body naturally, you program your brain to not recognize those particular situations as a threat. The result? Decreased incidences of anxiety and/or decreased self report of anxiety during these circumstances (Ex: anxiety goes from an 8 to a 4 on a scale of 1-10)
Sounds easy enough, right? Well, often times, anxiety disorders (and any disorders in general) are very tough to treat with psychotherapy interventions alone. It can feel like you are literally fighting against your own brain. So, using medication in conjunction with psychotherapy is typically the best possible option for reduction. Medication helps stabilize the chemicals in your brain, while the interventions activate the calm response. The result? Effective reduction in symptoms. Hint: this is why your therapist will often talk about the benefit of using medication and therapy together as opposed to just therapy. People tend to get better with both. What about those who don’t want to take medication or prefer natural solutions? Well, I totally understand! However, as a professional, I am required to tell my client’s that medication is the most evidence-based pharmacological option. Natural remedies might help, but this will be a trial and error thing for you. More research is needed on the effects of all those natural remedies out there.
Whew, we covered a lot! And I’m glad we did! I have one last thing I’d like to discuss in this blog: all the different diagnosis’ covered underneath the heading “anxiety disorders” in the DSM-5 (diagnostic and statistical manual of mental disorders). These include:
A lot of disorders, isn’t there? I’ll give just a brief overview of each disorder.
Separation anxiety disorder–disorder in children who have extreme anxiety when being separated from a parent of caregiver
Selective mutism–disorder typically associated with children who fail to speak in specific social situations, even though they have the ability to and this interferes with school or work functioning (if an adult)
Specific phobia–marked fear or anxiety surrounding specific objects or situations: flying, animals, natural environment (such as storms, heights, etc), blood injection injury (needles), situational (airplanes, elevators, enclosed spaces), and situations considered “other” but are likewise specific
Social anxiety disorder–marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others such as social interactions, being observed, and performing in front of others
Panic disorder–recurrent and unexpected panic attacks. If the panic attack is expected, it typically falls in a specific phobia diagnosis
Agoraphobia–marked fear or anxiety about two or more of the following situations: using public transportation, being in open spaces (marketplaces, bridges, parking lots), being in enclosed places (shops, theaters, cinemas), standing in line or being in a crowd, being outside of the home alone. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available
Generalized anxiety disorder– excessive anxiety and worry about a number of events or activities. the individual finds it difficult to control the worry and is associated with three or more of the following symptoms: restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance
Substance/medication-induced anxiety disorder–panic attacks or anxiety is predominant and there is evidence from the history, physical exam, or lab results that symptoms started during or soon after substance intoxication or withdrawal or after exposure to medication and the involved substance/medication is capable of producing the symptoms
Anxiety disorder due to another medical condition–panic attacks or anxiety with evidence from the history, physical exam, or lab results that the disturbance is the direct pathophysiological consequence of another medical condition
Other specified anxiety disorder– symptoms are characteristic of an anxiety disorder that cause significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any of the disorders in the anxiety diagnostic class
Unspecified anxiety disorder–the clinician chooses not to specify the reason the criteria are not met for a specific anxiety disorder, such as insufficient information to make a more specific diagnosis.
Hopefully, reading this blog has answered some of your questions! If you have further questions, feel free to email me! As always, do not self-diagnose. Meet with a qualified professional to be assessed for diagnosis.