What is anxiety?
We have all felt anxiety—the nervousness before a date, test, competition, presentation—but what exactly is it? Anxiety is our body's way of preparing to face a challenge. Our heart pumps more blood and oxygen so we are ready for action. We are alert and perform physical and emotional tasks more efficiently. (See also Test Anxiety for tips on dealing with tests.)
It is normal to feel anxious when our safety, health, or happiness is threatened; however, sometimes anxiety can become overwhelming and disruptive and may even occur for no identifiable reason. Excessive, lasting bouts of worry may reflect an anxiety disorder.
Symptoms of anxiety disorders:
Anyone may experience these symptoms during stressful times. However, individuals with anxiety disorders may experience them in absence of stress, with more severe symptoms and/or with several symptoms appearing together.
- Inability to relax
- Unrealistic or excessive worry
- Difficulty falling asleep
- Rapid pulse or pounding, skipping, racing heart
- Nausea, chest pain or pressure
- Feeling a "lump in the throat"
- Dry mouth
- Irregular breathing
- Feelings of dread, apprehension or losing control
- Trembling or shaking, sweating or chills
- Fainting or dizziness, feelings of detachment
- Thoughts of death
Types of Anxiety Disorders:
Generalized Anxiety Disorder (GAD) is characterized by chronic and exaggerated worry and tension, much more than the typical anxiety that most people experience in their daily lives. People may have trembling, twitching, muscle tension, nausea, irritability, poor concentration, depression, fatigue, headaches, light-headedness, breathlessness or hot flashes.
Panic Disorder: People with panic disorder have panic attacks with feelings of terror that strike suddenly and repeatedly with no warning. During the attacks, individuals may feel like they can't breathe, have lost control, are having a heart attack or even that they are dying. Physical symptoms may include chest pain, dizziness, nausea, sweating, tingling or numbness, and a racing heartbeat. Some people will have one isolated attack, while others will develop a long term panic disorder; either way, there is often high anxiety between attacks because there is no way of knowing when the next one will occur. Panic disorders often begin early in adulthood. Many people with panic disorder also suffer from agoraphobia (abnormal fear of open or public places.). See more on Panic Attacks.
Phobias are irrational fears. Individuals with phobias realize their fears are irrational, but thinking about or facing the feared object or situation can bring on a panic attck or severe anxiety.
Phobias are often fears of a particular object or situation. Commonly feared objects and situations in specific phobias include animals, tunnels, water and heights. The most common specific phobia is fear of public speaking.
Social Phobia, or Social Anxiety Disorder, is characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People with social phobia have a fear of being judged by others, being embarrassed or being humiliated. This fear may interfere with work or school and other ordinary activities.
Obsessive-Compulsive Disorder (OCD) is characterized by uncontrollable anxious thoughts or behaviors. Individuals with OCD are plagued by persistent, unwelcome thoughts and images or by the urgent need to engage in certain rituals. Some OCD sufferers may only have obsessive thoughts without the related rituals. The disturbing thoughts or images (e.g., fear of germs) are called obsessions, and the rituals performed to try to get rid of them (e.g., hand washing) are called compulsions. For example, people who are obsessed with germs may wash their hands excessively. The individual is not happy to be performing the ritual behaviors but finds this to be the only way to get temporary relief from the obsessive thought.
Post-Traumatic Stress Disorder affects people after terrifying events such as physical or sexual abuse, car accidents, war or natural disasters. Individuals with PTSD may experience depression, flashbacks, nightmares, sleep difficulties, irritability, aggression, violence, and a feeling of detachment or numbness. Symptoms can be triggered by anything that reminds the individual of their trauma.
What is a panic attack?
Panic attacks can be caused by heredity, chemical imbalances, stress and the use of stimulants (such as caffeine or drugs).
Some people have only one or two attacks and are never bothered again. Panic attacks can occur with other psychiatric disorders. In panic disorders, however, the panic attacks return repeatedly and the person develops an intense fear of having another attack. Without help, this "fear of fear" can make people avoid certain situations and can interfere with their lives even when they are not having a panic attack. Therefore, it is very important to recognize the problem and get help.
Tips for dealing with a panic attack
(Adapted from "Understanding Panic Disorders," National Institute of Health)
- Realize that although your symptoms are frightening, they are an exaggeration of normal stress reactions and aren't dangerous or harmful.
- Face the feelings rather than fighting them, and they will become less intense.
- Don't add to the panic by asking "What if?" Tell yourself "So what!"
- Stay in the present. Notice what is actually happening rather than what you think might happen.
- Rate your fear level on a scale of 1 to 10 and watch it change. Notice that it doesn't stay at a high level for more than a few seconds.
- Distract yourself with a simple task like counting backwards or lightly snapping a rubber band around your wrist.
- When the fear comes, expect it and accept it. Wait and give it time to pass without running away.
Tips for helping someone with an anxiety disorder:
- Make no assumptions—ask the person what they need.
- Be predictable—don't surprise the person.
- Let the person with the disorder set the pace for recovery.
- Find something positive in every small step towards recovery.
- Don't help the person avoid their fears.
- Maintain your own life so you don't resent the person with the disorder.
- Don't panic when the person with the disorder panics, but realize it's natural to be concerned with them.
- Be patient and accepting, but don't settle for the affected person being permanently disabled.
- Say encouraging words such as: "You can do it no matter how you feel. I am proud of you. Tell me what you need now. Breathe slow and low. Stay in the present. It's not the place that's bothering you, it's the thought. I know that what you are feeling is painful, but it's not dangerous. You are courageous."
- Avoid saying things like: "Don't be anxious. Let's see if you can do this. You can fight this. What should we do next? Don't be ridculous. You have to stay. Don't be a coward." These phrases tend to blame the individual for the anxiety.
When should I get help?
Some people believe that anxiety disorders can be overcome with willpower, but this is not likely. Untreated anxiety disorders can lead to depression, substance abuse and a range of other problems. If your normal routine is interrupted by excessive worry, you should seek help from a professional.
If you, or someone you know, has symptoms of anxiety disorder, visit a clinician, who can help determine whether the symptoms are due to an anxiety disorder, medical condition or both. Frequently, the next step in getting treatment for an anxiety disorder is referral to a mental health professional such as a psychiatrist, psychologist, social worker or counselor.
In general, two types of treatment are available, medication and psychotherapy (sometimes called "talk therapy"). Both can be effective for most disorders. The choice of one or the other, or both, depends on the patient's and the clinician's preference, and also on the particular anxiety disorder.
For more information:
UHS Clinical Social Workers can provide additional recommendations and referrals