Making sense of anxiety
It’s natural to worry during the stressful times we all experience from time to time in life. Someone with an anxiety or related disorder, however, feels persistently anxious in a way which is excessive and out of keeping with the situation they are in.
Understanding how anxiety disorders ‘work’ then, is an important first step in taking control of symptoms and getting better.
What causes Anxiety disorders?
Anxiety disorders are thought to be caused by a combination of factors. Most anxious people are probably born with a genetic vulnerability to develop an anxiety disorder. Personality traits and responses to stressful life events may trigger the condition or make it worse.
Common stressful life events include:
- being in an unpredictable new situation such as a change of school or workplace, or travelling overseas.
- break-up of a relationship.
- experiencing the death of somebody close.
- financial or work problems.
- experiences during early childhood.
- excessive drug or alcohol use.
- physical health problems.
What do people experience if they have Anxiety disorder?
When someone has an anxiety disorder, the worry and discomfort they experience is persistent (lasting six months or longer). It can express itself physically as well as psychologically, and also affect behaviour.
These changes in how someone feels, thinks, and acts can then start to interfere with their ability to live a normal life, to work, and to relate to other people.
Psychological symptoms of Anxiety disorder
Anxiety disorders vary and affect people in different ways and to different degrees, but common psychological symptoms include:
- excessive feelings of dread and worry about what might happen in the future.
- persistent worry and endlessly thinking about events in the past.
- obsessive thoughts which are difficult to stop.
- feelings of panic and fear in situations where there is no actual danger.
Physical symptoms of Anxiety disorder
Anxious thoughts and feelings can lead to physical responses too, as the body reacts to the ‘false alarm’ of anxiety. It goes into ‘flight or fight’ mode, as though you were in real danger and had to act fast:
- breathing faster
- muscle tension – for example, aching back, shoulders, or jaw
- trembling and sweating
- chronic headaches
- stomach problems or nausea
- feeling frequently weary, even after sleep
- restlessness and difficulty relaxing and sleeping.
These physical symptoms can sometimes occur without awareness that they are associated with anxiety.
How Anxiety disorders can affect people’s lives
It’s understandable that people will change their behaviour to try to avoid distressing symptoms of Anxiety disorders. This can then start to have an impact on their lives.
Someone with a Social anxiety disorder, for example, will avoid situations where other people are present. This can lead to them having no social life, experiencing great loneliness, and even stopping them from working.
Anxiety disorders are often accompanied by depression, so that both will need to be treated – see Depression).
People who experience psychotic symptoms such as delusions and hallucinations – such as those with schizophrenia, for example – may also experience symptoms of an anxiety disorder – see Bipolar disorder and Schizophrenia.
What are the different types of Anxiety disorders?
Each person’s experience of an Anxiety disorder can be very individual, but common forms include:
Generalised anxiety disorder (GAD)
GAD is characterised by persistent worry that the person realises is excessive or unrealistic. It can be about almost anything – money, work, health, relationships or being harmed.
People affected by GAD often worry and ruminate over everyday events in their life, until these assume a significance out of proportion to reality.
Constantly reacting to fearful thoughts and feelings, they may often feel irritable, nervy, and haunted by a sense of unease and dread. Sleeping problems are also common.
People may drink alcohol excessively in order to ‘take the edge’ off this sense of general anxiety.
Phobias are intense, irrational fears about specific objects or situations – for example, a fear of heights, storms, dogs, enclosed spaces, snakes or spiders where the danger is greatly overestimated.
Many people affected try to cope by avoiding the feared objects or situations. They may not recognise that they have an anxiety disorder. These fears can interfere with a person’s life, and can occur when someone has another form of anxiety disorder too.
Panic disorder involves frequent sudden attacks of intense fear (panic attacks). These may occur when a person feels ‘trapped’. They may even feel as if they are about to die.
When someone experiences panic they may feel breathless, dizzy, choking, or faint. They may feel their heart pounding. It is common for people to believe that these symptoms are caused by a serious physical condition such as a heart attack or stroke.
Because these physical symptoms are distressing and frightening, the person experiencing them becomes even more anxious and fearful of ‘triggering’ them. They may start to avoid situations associated with feelings of panic, or in which they feel they could not escape or get help – such as on public transport, in crowded places, or being completely alone.
Social anxiety disorder
Social anxiety disorder involves intense anxiety associated with social situations, such that the person’s ability to live a normal life is affected. There is an intense fear of embarrassing oneself in public or being scrutinised by others.
This anxiety can lead to physical symptoms such as blushing, sweating, shaking and heart pounding, which in themselves can cause embarrassment.
Social anxiety disorder may initially occur in only certain situations (such as public speaking or large gatherings), but it can spread to involve any type of social interaction.
Those affected often react by becoming withdrawn or avoiding social situations, or by drinking alcohol excessively when attending them, which can lead to further problems.
Anxiety disorders are closely related to three other types of disorders
Anxiety disorders are closely related to Obsessive compulsive and related disorder (OCD), Hoarding disorder and Trauma and stress-related disorders. It is not uncommon for people with these conditions to experience symptoms of anxiety.
Obsessive compulsive disorder (OCD)
OCD is characterised by intrusive thoughts about unpleasant things that might happen. OCD is highly distressing for the person experiencing it and for those who care about them.
Common concerns include fear of contamination from germs, intrusive sexual thoughts, fears about leaving doors unlocked or appliances turned on, and fears of violence or causing harm to others.
The person may feel compelled to ritually check, clean, or count. They may avoid situations where their fears might be triggered or where they don’t feel they can trust themselves.
Hoarding disorder is characterised by a persistent difficulty discarding or parting with possessions due to a perceived need to save the item, regardless of its actual value. The person may experience significant distress and anxiety if and when they try to discard the items that they have collected.
Trauma and stress-related disorders
Trauma and stress related disorders follow a traumatic event which causes intense fear or feelings of helplessness. Witnessing a traumatic event directly or indirectly can also lead to this condition.
The symptoms typically develop shortly after the event, although it may take years before they develop. Symptoms include re-experiencing the trauma through nightmares, rumination, and flashbacks.
People affected may avoid situations, people, and objects which remind them of the traumatic event. For example, after a serious car accident, someone might avoid driving or being a passenger in a car.
There is also increased anxiety in general and the person may become very jumpy and startled easily. Some people find themselves less emotionally responsive to others, describing themselves as feeling emotionally ‘numb’.