On Anxiety

Exploring Anxiety Disorders

Anxiety is one of the most common psychological problems facing individuals today. Most people experience feelings of anxiety before an important event such as a big exam, business presentation, or first date. Anxiety Disorders, however, are illnesses that fill people’s lives with overwhelming feelings of fear and dread that are unremitting and can grow progressively more disturbing.

Anxiety Disorders occur as a result to the disruption of the brain’s warning system, making relatively safe and normal situations seem very threatening and dangerous. Although many people have difficulty with anxiety and worry, individuals with Anxiety Disorders experience these to a degree that severely interferes with their lives and ability to function. For these individuals, the anxiety and fears are often overwhelming.

The characteristics and experiences of the different Anxiety Disorders overlap quite a bit. A person with Obsessive-Compulsive Disorder, for example, may also show features of Generalised Anxiety Disorder at times. Anxiety concerns respond well to psychological treatment.

GAD

Generalised Anxiety Disorder (GAD) is characterised by excessive and exaggerated worry. and tension about a wide variety of issues even though there is little or no reason to objectively be worried. Individuals affected by GAD anticipate disaster and are overly concerned about health issues, finances, family problems, or difficulties at work. Sometimes just the thought of getting through the day produces anxiety.

People with GAD have a sustained “fight or flight” response to stressful situations. When people are faced with danger, their brains release chemicals, such as adrenalin, noradrenalin and cortisone, that prepare them to fight or run away . When these hormones are released into the bloodstream, complex patterns of nerve cell firing occur. Our body is put on a state of high alert. Our breathing and heart rate quickens. Our muscles are tightened. We become hyper-vigilant and sensitive and our body’s entire focus is to repel the threat. Normally, this reaction dwindles once a person is not longer threatened. In people with GAD, however, this response is sustained over weeks or months, which can cause a host of negative effects for physical health and mental well-being.

Symptoms of GAD

The defining symptom of GAD is intrusive and exaggerated worry about a broad range of concerns. Sufferers of GAD have a hard time controlling this tendency to worry. In addition there are number of physical symptoms, such as:

  •   Feeling tired or irritable; having a hard time concentrating
  •   Having headaches or muscle aches
  •   Having a hard time swallowing
  •   Feeling shaky, sweating or having hot flashes
  •   Feeling light headed, sick to your stomach, or out of breath
  •   Having to go to the bathroom often
  •   Feeling like you can’t relax or  being startled easily
  •   Having problems falling or staying asleep

Panic Disorder and Panic Attacks

A panic attack is a sudden, intense fear or heightened anxiety that may make a person short of breath, dizzy or make their heart pound. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control. Some people believe they are having a heart attack or are about to die. Therefore panic attacks can be scary and so distressing that they interfere with a person’s daily activities. An attack may last from 5 to 20 minutes. The most anxiety is experienced about 10 minutes after the attack starts. If these attacks happen often, they are called Panic Disorder. Treatment can help most people have fewer symptoms and/or stop the attacks.

Symptoms of Panic Attacks may include :

  • A feeling of intense fear, terror, or anxiety
  • Trouble breathing or very fast breathing
  • Chest pain or tightness
  • A heartbeat that races or is not regular
  • Sweating
  • Nausea or an upset stomach
  • Dizziness and shaking
  • Numbness or tingling

Symptoms of Panic Disorder may include :

  • Repeated panic attacks when there is no obvious reason for the fight-or-flight response to be activated.
  • Changing daily activities because you worry that you will have another attack.

Post Traumatic Stress Disorder (PTSD)

After an event in which a person feels seriously threatened it is normal for them to feel frightened, sad, anxious, and disconnected. However, if the upset doesn’t fade and the person becomes stuck with a constant sense of danger and painful memories, they may be experiencing symptoms of Post-Traumatic Stress Disorder (PTSD). This disorder arises as a delayed or protracted response to a stressful event of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone (for example, natural or man-made disaster, combat, serious accident, witnessing the violent death of others, or being the victim of torture, terrorism, rape, or other crime).

Symptoms of PTSD

PTSD can cause many symptoms. These symptoms can be grouped into three categories:

  1. Re-experiencing the event: The individual may have difficulty in recalling the event voluntarily, but despite this, may involuntarily experience intense images from the trauma (often described as “flashbacks” or “like a video”), intrusive frightening thoughts or have recurring painful dreams about aspects of the event.
  2. Avoidance of cues and emotional numbing: The second group of symptoms includes avoidance of reminders of the event coupled with a decreased ability to feel emotion, a sense of detachment, and feeling of having a lack of interest in one’s surroundings.
  3. Hyper-arousal: These symptoms include insomnia, poor concentration, anxiety and irritability. There may be autonomic disturbances. The person may be always on alert mode and easily startled.

The onset of PTSD is generally a few weeks to up to six months after the traumatic event.

Complex Post Traumatic Stress Disorder

People who have repeatedly experienced severe neglect, abuse or violence as a child or adult may develop complex PTSD.

As well as the symptoms of PTSD, suffers may also:

  • Feel shame and guilt
  • Isolate themselves
  • Became unwilling to talk about their emotions
  • Feel impulsive and take excessive risks
  • Symptoms may be experienced for months or even years

Acute Stress Disorder

This is a transient experience of emotional disturbance arising in response to stress. Individuals show anxiety or other emotional distress, hyper-arousal and dissociative symptoms. The condition begins to diminish after 8 hours but it can last for more than 48 hours and up to 4 weeks. If the condition continues then it is re-classified, either as Adjustment Disorder or PTSD. There is not always a link between Acute Stress Disorder and PTSD. Not all individuals with Acute Stress Disorder go on to develop PTSD, nor have all those with PTSD gone through a stage of acute stress disorder.

OCD

We all have habits; some of these may come from being worried or unsure. A person might have to double-check the front door of the house is locked when they leave the house or they may always cross their fingers for good luck. For people with Obsessive Compulsive Disorder (OCD), these habits take over. They can profoundly disturb their day to day life. OCD is characterised by the presence of intrusive and upsetting thoughts (obsessions) and the use of rituals (compulsions) to control the anxiety these thoughts produce. Although temporary relief may be found from engaging in these repetitive behaviours, the obsessive thoughts and ultimately the repetitive behaviours often re-emerge. The symptoms of OCD can dramatically interfere with everyday functioning and often requires intervention.

OCD can respond well to treatment with certain medications and/or exposure based psychological interventions, in which people face situations that cause fear or anxiety and become less sensitive (desensitised) to them.

Obsessions

These are thoughts or images that are out of our control. They intrude into our awareness when we don’t want them to. They can be upsetting and hard to stop. Lots of things can set them off. By and large, obsessions come from feeling unsure or scared. They can cause a lot of worry and people can feel trapped by the thoughts running through their mind.

Common Obsessions

  • Fear of dirt, germs or getting ill.
  • Fear of acting out violent thoughts or harming others.
  • Worrying about order, things being correct.
  • Upsetting images that are blasphemous, sexual or morally wrong.

Compulsions

These are the things that people do to ‘correct’ or ‘put right’ obsessions. Often compulsions don’t make much sense. People will do the same thing over and over again. This way of coping can make them feel in control. It can make them better, but only for a short time. Compulsions don’t have to be actions. They can also be mental acts like counting, or people might try to swap a bad mental picture with a good one.

Common Compulsions

  • Washing/Cleaning
  • Checking
  • Avoiding things
  • Asking for comfort from others
  • Thinking “good” thoughts

BDD

Almost everyone feels unhappy about the way they look at some point in their life, but these thoughts usually come and go and can be forgotten. However, for someone with Body Dysmorphic Disorder (BDD), the thought of a flaw is very distressing and does not go away.

Although BDD is not the same as Obsessive Compulsive Disorder (OCD), there are similarities. For instance, the person may have to repeat certain acts, such as combing their hair, applying make-up, or picking their skin to make it ‘smooth’. It can seriously affect daily life, often affecting work, social life and relationships.

BDD is an Anxiety Disorder that causes sufferers to spend a lot of time worrying about their appearance and to have a distorted view of how they look. For example, they may be convinced that a barely visible scar is a major flaw that everyone is staring at, or that their nose looks abnormal. Having BDD does not mean the person is vain or self-obsessed.

People with BDD may :

  • Constantly compare their looks with other people’s
  • Spend a long time in front of a mirror, and at other times avoid mirrors altogether
  • Spend a long time concealing what they believe is a defect
  • Become distressed by a particular area of their body (commonly their face)
  • Feel anxious when around other people
  • Are very secretive and reluctant to seek help because they believe others will see them as vain or self-obsessed
  • Seek medical treatment for the perceived defect – for example, they may have cosmetic surgery or excessively diet and exercise, which is unlikely to relieve their distress.