Anxiety

Anxiety

Anxiety is the feeling of being fearful and tense with one or more unpleasant physical symptoms. For example, a fast heart rate, a thumping heart (palpitations), feeling sick, shaking (tremor), sweating, dry mouth, chest pain, headaches, fast breathing.

The physical symptoms are partly caused by the brain which sends messages down nerves to various parts of the body when a person is anxious. The nerve messages tend to make the heart, lungs, and other parts of the body work faster. In addition, stress hormones (such as adrenaline) are released into the bloodstream which act on the heart, muscles and other parts of the body to cause symptoms.

Anxiety is normal in stressful situations, and can even be helpful. For example, most people will be anxious when threatened by an aggressive person, or before an important race. The burst of adrenaline and nerve impulses in response to stressful situations can encourage a ‘fight or flight’ response.

Anxiety is abnormal if it:

  • Is out of proportion to the stressful situation; or
  • Persists when a stressful situation has gone, or the stress is minor; or
  • Appears for no apparent reason when there is no stressful situation.

What are anxiety disorders?

There are various conditions (disorders) where anxiety is a main symptom. An anxiety disorder exists if anxiety symptoms interfere with normal day-to-day activities, or if worry about developing anxiety symptoms affects life. About 1 in 20 people have an anxiety disorder at any one time. The following is a brief overview of the main anxiety disorders. Some people have features of more than one type of disorder.

Reactions to stress

Anxiety can be one of a number of symptoms as a reaction to stressful situations. There are three common types of reaction disorders:

Acute reaction to stress (sometimes called acute stress reaction)

Acute means the symptoms develop quickly, over minutes or hours, reacting to the stressful event. Acute reactions to stress typically occur after an unexpected life crisis such as an accident, bereavement, family problem, bad news, etc. Sometimes symptoms occur before a known situation which is difficult. This is called situational anxiety.

Symptoms usually settle fairly quickly, but can sometimes last for several days or weeks. Apart from anxiety, other symptoms include low mood, irritability, emotional ups and downs, poor sleep, poor concentration, wanting to be alone.

Adjustment reaction

This is similar to the above, but symptoms develop days or weeks after a stressful situation, as a reaction or adjustment to the problem. For example, as a reaction to a divorce or house move. Symptoms are similar to acute reaction to stress but may include depression. The symptoms tend to improve over a few weeks or so.

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) may follow a severe trauma such as a serious assault or life-threatening accident. Symptoms last at least one month, often much longer. Anxiety is only one symptom which may come and go. The main symptoms of PTSD are:

  • Recurring thoughts, memories, images, dreams, or flashbacks of the trauma, which are distressing.
  • Avoidance of thoughts, feelings, conversations, places, people, activities or anything else which may trigger memories or thoughts of the trauma.
  • Feeling emotionally numb and detached from others.
  • Pessimistic outlook for the future Loss of interest in activities which were previously enjoyed.
  • Increased arousal which didn’t exist before the trauma. This may include difficulty sleeping, being irritable, difficulty concentrating, and increased vigilance.

Phobic anxiety disorders

A phobia is strong fear or dread of a thing or event. The fear is out of proportion to the reality of the situation. Coming near or into contact with the feared situation causes anxiety. Sometimes even thinking of the feared situation causes anxiety. Therefore, in avoiding the feared situation, life can be restricted and may cause suffering.

There are many other phobias of a specific thing or situation. For example:

  • Fear of confined spaces or of being trapped (claustrophobia).
  • Fear of certain animals.
  • a fear of public places and open spaces.
  • Fear of injections.
  • Fear of vomiting.
  • Fear of being alone.
  • Fear of choking.

But there are many more.

Social anxiety disorder

Social anxiety disorder (also known as social phobia) is possibly the most common phobia. With social anxiety disorder persons become very anxious about what other people may think of them, or how they may be judged. Therefore, there is a fear of meeting people, or ‘performing’ in front of other people, especially strangers.

Other anxiety disorders

Panic disorder

Panic disorder means that one gets recurring panic attacks. A panic attack is a severe attack of anxiety and fear which occurs suddenly, often without warning, and for no apparent reason. The physical symptoms of anxiety during a panic attack can be severe and include a thumping heart (palpitations), trembling, feeling short of breath, chest pains, feeling faint, numbness, or pins and needles. Each panic attack usually lasts 5-10 minutes, but sometimes they come in waves for up to two hours.

Generalised anxiety disorder

In a generalised anxiety disorder (GAD) there is a lot of anxiety (feeling fearful, worried and tense) on most days. The condition persists long-term. Some of the physical symptoms of anxiety (detailed above) may come and go. The anxiety tends to be about various stresses at home or work, often about quite minor things.

Mixed anxiety and depressive disorder

In some people, anxiety can be a symptom when they have depression. Other symptoms of depression include low mood, feelings of sadness, sleep problems, poor appetite, irritability, poor concentration, decreased sex drive, loss of energy, guilt feelings, headaches, aches, pains, and palpitations. Treatment tends to be aimed mainly at easing depression, and the anxiety symptoms often then ease too.

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) consists of recurring obsessions, compulsions, or both.

  • Obsessions are recurring thoughts, images, or urges that cause anxiety or disgust. Common obsessions are fears about dirt, contamination, germs, disasters, violence, etc.
  • Compulsions are thoughts or actions that a person feels he/she must do or repeat. Usually a compulsion is a response to ease the anxiety caused by an obsession. A common example is repeated hand washing in response to the obsessional fear about dirt or germs. Other examples of compulsions include repeated cleaning, checking, counting, touching, and hoarding of objects.

What is the treatment for anxiety disorders and phobias?

The main aim of treatment is to help reduce symptoms so that anxiety no longer affects day-to-day life.

The treatment options depend on what condition a person has, and how severely they are affected. They may include one or more of the following:

NON-MEDICATION TREATMENTS

Understanding

Understanding the cause of symptoms, and talking things over with a friend, family member or health professional may help. In particular, some people worry that the physical symptoms of anxiety, such as a thumping heart (palpitations), are due to a physical illness. This can make anxiety worse. Understanding that that one has a anxiety disorder is unlikely to cure it, but it often helps.

Counselling

This may help some people with certain conditions. For example, counseling which focuses on problem-solving skills may help in case of GAD.

Self-help

There are books, tapes, videos, etc on relaxation and combating stress. They teach simple deep-breathing techniques and other measures to relieve stress, help one relax, and possibly ease anxiety symptoms.

MEDICATION

Antidepressant medicines

These are commonly used to treat depression, but also help to reduce the symptoms of anxiety even if not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing anxiety symptoms.

  • Antidepressants do not work straightaway. It takes 2-4 weeks before their effect builds up and the anxiety symptoms are helped. A common problem is that some people stop the medicine after a week or so, as they feel that it is doing no good. This is often too soon to know if the medication will work.
  • Antidepressants are not tranquillisers, and are not usually addictive.
  • There are several types of antidepressants, each with various pros and cons. They may differ in their possible side-effects.
  • These should be taken only if and as prescribed by a doctor.

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