What Is Anxiety & Worry?
Anxiety is fear in action. It is a normal feeling that all of us experience when we are about to face a threat or stressful event. It occurs even before we have come face to face with whatever it is we are fearful of, for example, an examination or a job interview.
How Does Worry Help Us?
When we worry we are being vigilant for possible threats. Worry is our attempt at mentally fixing problems that haven’t as yet happened. We might ask a lot of “What If” questions: What if this or that happened? Unfortunately, often worry doesn’t bring about resolution to a problem and we are left in the dark, as it were, worried about something we can’t predict. I remember reading a placard that said:” Worrying is like a rocking chair, it will give you something to do, but it won’t get you anywhere”. I don’t entirely agree, but there’s a lot of truth in the statement.
When Does Worrying Become A Problem?
Worrying becomes a problem when the threat or danger has past, but we are still thinking and feeling as if it hasn’t, or we immediately fixate on some other danger or threat that replaces the last. Now we are talking about severe anxiety. Without realizing, we start linking one anxious thought to the next to the point where our feelings are now so intense and long lasting they start to interfere with our daily lives and stop us from doing the things that are important to our survival, like, for example, focusing on what we are supposed to be doing in the present. When our attention is elsewhere we are more prone to making mistakes in the workplace, having accidents, losing and or misplacing things. Also, because we are so preoccupied with the fear of some impending danger, we tend to be less tolerant of others resulting in higher levels of conflict with the people aroud us.
How Do I Know If I Have an Anxiety Problem?
There are several types of anxiety disorders, the most common being Generalized Anxiety Disorder (GAD). For a brief outline of the symptoms of some of the other anxiety disorders please click on the left side of the page.
General Anxiety (DSM-V)
- Excessive anxiety and worry, occurring more days than not for at least six months, about a number of events or activities such as, work, relationships, finances, children, school, etc.
- The person finds it difficult to control the worry.
- The person has three or more of the following symptoms: they feel (a) restless or wound up (b) easily fatigued (c) have difficulty concentrating (d) they feel irritable (e) they have muscle tension and (f) they have sleep disturbance: difficulty falling or staying asleep or restless, unsatisfying sleep.
Panic Attacks (DSM-1V)
Panic Attacks don’t occur in isolation of other Anxiety Disorders. For example, they can occur in Social Phobia where the person has a fear of social or performance situations in which embarrassment may occur, like parties, community events or public speaking. Or, Specific Phobia where the person has a fear of clearly discernable objects or situations like, snakes, spiders or dogs. Panic Attacks are also tied to a variety of other Anxiety Disorders such as: Post Traumatic Stress Disorder PTSD and Acute Stress Disorder, both of which will be discussed in more detail shortly. For now, let’s look at the symptoms of a Panic Attack.
Panic Attack Symptoms (DSM-IV)
The criteria for Panic Attack is when there is a discrete period of intense fear or discomfort, in which four or more of the following symptoms developed abruptly and reached a peak within 10 minutes:
- Palpitations, pounding heart, or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light headed, or faint
- Feeling detached from oneself
- Fear of losing control, or going crazy
- Fear of dying
- Numbness or tingling sensations
- Chills or hot flushes
The median age of onset of Agoraphobia is about 20 years. People with Agoraphobia have intense anxiety about, or avoidance of, places or situations from which escape might be difficult or embarrassing or in which help might not be available if the person had a Panic Attack or panic like symptoms (DSM – 1V). The condition leads sufferers to avoid a variety of situations that may include:
- Being alone outside the home or being home alone
- Being in a crowded place like a shopping centre, a queue; travelling in a bus, train or airplane or being in an elevator
Specific Phobia (DSM-1V)
Specific Phobia is characterizes by severe anxiety provoked by the person coming into contact with Animal Types such as, insects snakes, spiders or bees or Natural Environment Types like, thunder storms, heights or large amounts of water. There is also Blood-Injection Injury Type such as seeing blood or having to have a needle or other invasive medical procedures. Specific Phobia can also be Situational: fear of public transport, tunnels or having to go over a bridge, flying or elevators. This particular type of Specific Phobia can peak in childhood, and then have a second peak in the mid twenties. Some people experience a fear of choking, vomiting or fear of contracting an illness; children may fear loud sounds or costume characters (DSM – 1V). In adults, the most frequent subtype is Situational, and then Environmental followed by Blood Injection Injury to the least feared in adults being Animals.
Obsessive Compulsive Disorder: OCD (DSM-1V)
The essential features of Obsessive Compulsive Disorder are recurrent obsessions or compulsions that take up a great deal of the person’s time, ie. more than one hour per day, (Diagnostic & Statistical Manual of Mental Disorders:( DSM – 1V). Obsessions can be persistent ideas, thoughts, impulses or images that are experienced as intrusive and inappropriate and that cause a high level of anxiety or distress. The most common obsessions are repeated thoughts about contamination from shaking someone’s hand, or touching an object, or repeated doubts about whether one has left a door unlocked, the oven on, or that one has hurt someone in an accident. Other obsessions are about order; particular items must be ordered or asymmetrical; or aggressive impulses to yell out obscenities in a Church. What is a Compulsion? Compulsions are repetitive behaviours like hand washing, putting things in order, checking, or mental acts like praying, counting, repeating words silently all of which serve the purpose of preventing or reducing anxiety. For example, if I say the Lord’s Prayer two hundred times before breakfast, then my obsessive thought that something bad is going to happen to a family member will be neutralized; nothing bad will happen because of my prayers, therefore, my anxiety decreases. How Would I Know If I had OCD? If you are distressed by obsessive thoughts, images or ideas that compel you to behave in particular ways, eg wash your hands, check doors, count, etc which take more than one hour per day, and significantly interferes with your normal routine, occupational functioning and relationships, then you need to speak to a psychologist or counsellor experienced in dealing with anxiety disorders.
Social Phobia (DSM-1V)
The essential feature of Social Phobia is marked and persistent fear of social or performance situations in which embarrassment may occur, like fear at the thought of having to give a speech or just simply meeting new people. Some individuals may experience a Panic Attack prior to entering or during the situation that causes distress. Consequently, some people will avoid social or performance situations. How Would I know If I had Social Phobia? If the fear or avoidance of social or performance situations interferes significantly with your normal routine, occupation, social life and relationships, then social anxiety might be the problem. Social Phobia can also negatively affect the couple system. For example, one of my clients repeatedly found excuses to avoid having to attend social functions with his partner which resulted in their relationship almost coming to an end. She was new to Sydney and was beginning to feel isolated and bored being with someone who preferred staying home week in and week out.
Post Traumatic Stress Disorder (PTSD) (DSM-1V)
Post Traumatic Stress Disorder may result from a person having experienced, witnessed or been confronted with an event, like a robbery, , sever domestic violence, sexual assault, natural or manmade disasters, automobile accident or war, that involved actual or threatened death or serious injury to self or others and where their response was intense fear, helplessness or horror. What are the Symptoms of PTSD? The traumatic event must persistently be re-experienced in one or more of the following ways: (a) Recurrent and intrusive distressing recollections of the event, including images, thoughts (b) Recurrent distressing dreams of the event; in children it might be frightening dreams that have nothing to do with the event he or she experienced (c) Acting or feeling as if the traumatic event were recurring, i.e. reliving the experience, illusions, hallucinations and flash-back episodes including those that occur on awakening or when intoxicated; in children they may re-enact the trauma (d) Intense psychological distress and physiological reactivity (increase in heart rate, blood pressure, trembling) on exposure to something or someone in the environment that symbolizes or resembles an aspect of the trauma (e) Persistent avoidance of any stimuli associated with the trauma, for example, conversations about the trauma, places, activities or people that remind you of the trauma (f) Feeling detached from others, inability to recall an important aspect of the trauma, loss of interest in significant activities (g) Difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance (watchful) and easily startled If you or someone close to you has experienced a number of the symptoms outlined above for more than one month, then it’s important that you contact a mental health professional as soon as possible. Delayed Onset: In some cases, a person may not experience any symptoms until six months after the traumatic event. Acute: If duration of symptoms is less than 3 months Chronic: If duration of symptoms is 3 months or more
Acute Stress Disorder (DSM-1V)
Acute Stress Disorder is similar to Post Traumatic Stress Disorder (PTSD) in that the individual was exposed to an extreme traumatic event, like a robbery, sever domestic violence, sexual assault, natural or manmade disasters, an automobile accident, or war that involved actual or threatened death or serious injury to self or others and where their response was intense fear, helplessness or horror. The difference between the two disorders is that the symptoms of Acute Stress Disorder must last for a minimum of two days and a maximum of four weeks and occur within one month of the traumatic event. If the symptoms of Acute Stress Disorder last for more than one month, then a diagnosis of PTSD must be considered.