Anxiety: A General Overview

Anxiety is experienced by most people. Anxiety is defined in a general sense as fear. Anxiety/fear is a necessary component of survival, as the flight-or-fight response is hard-wired in our brains to help us deal with acute danger in the environment…when we perceive danger, we either run away from the danger, or we stop to prepare to handle the danger if needed.

Anxiety is also needed for healthy development…without anxiety, we would be too comfortable in our current state, and would be less likely to change and be successful. For example, a deadline at work or school comes up, and the anxiety felt by the looming deadline helps us work harder to fulfill the project by the deadline. Without anxiety, we become complacent and we are less likely to meet the deadline or complete the project. Anxiety is needed in healthy doses to develop and achieve goals in life. People who excel under pressure are masters of utilizing their anxiety to their advantage to achieve. I have 5 articles to write by the end of this week, and the anxiety of writing this article by the deadline helps me to take time from my busy schedule to sit down and research and write about the topic by the deadline, and my anxiety over whether this article will hit home to the readers helps me to guide the content of this article to the intended audience. And the negative feedback I get from the editor about the content of this article will pique my anxiety once again to edit and change the article to the point where positive feedback is received.

At times, anxiety gets overwhelming…we all get “stressed-out” to the point where our worries and fears become so prominent that the anxiety take on a life of its own, so that we are not able to function and be unhappy over not being able to achieve what we are so worried about. Some can handle these brief episodes of stressed-out periods, and recover to once again have healthy anxiety, which helps one to perform and have good feelings about oneself. However, others may not be able to recover from stress, and the anxiety starts to affect our functioning and quality of life.

This article and the future articles on anxiety are for those who are not able to handle the anxiety, and need further help to recover. Those who are not able to handle the anxiety have either adjustment problems, or have an anxiety disorder. Unfortunately, psychiatry is not able to apply an objective test, such as a blood test or brain scan, to determine if one has an anxiety disorder. At this time, diagnosis of an anxiety disorder is based on clinical observations of the psychiatrist, physician, or PhD psychologist, and also based on history from the patient and family/friends who witness the behaviors.

Many problems with anxiety stem from adjustment problems. By this, one becomes overwhelmed with life circumstances that cause the anxiety to be overwhelming. Adjustment problems may stem from numerous causes, such as loss of a loved one, increasing obligations at work/school, loss of employment, financial problems, relationship problems, just to name a few. Some of these adjustment problems with anxiety may be resolved by addressing the life circumstance which triggered the anxiety. Others may benefit from counselling to address the address the anxiety. Still, others with adjustment problems with anxiety may benefit from supplements and lifestyle changes, which will be covered in future articles in this series.

Anxiety disorders are more severe than adjustment problems with anxiety. Anxiety disorders occur when the anxiety becomes overwhelming, affects functioning, affects quality of life and lasts for a significant time period. As mentioned previously, there is currently no objective test to diagnose an anxiety disorder…this is a clinical diagnosis performed by a qualified clinician (psychiatrist, physician or PhD psychologist). It is crucial to go to a qualified clinician if one is concerned of having an anxiety disorder. If in doubt, the diagnostic assessment is best performed by psychiatrists, who are experts at psychiatric disorders such as anxiety disorders.

The 6 main anxiety disorders are Generalized Anxiety Disorder, Specific Phobia, Social Anxiety Disorder (Social Phobia), Panic Disorder, Obsessive Compulsive Disorder and Post Traumatic Stress Disorder. (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000):

Generalized Anxiety Disorder (GAD) is characterized by excessive worry about events and activities, and this interferes with one’s normal functioning. One knows the worry is excessive, yet has difficulty controlling the worry. The physical symptoms of generalized anxiety disorder include:

• Restlessness
• Fatigue
• Irritability
• Muscle tension
• Difficulty concentrating
• Sleep disturbance

Specific Phobia is characterized by extreme fear of an object or situation. The feared object or situation is avoided as much as possible, as exposure may induce a panic attack. Examples of feared objects include fear of spiders and fear of computers. Examples of feared situations include fear of heights, fear of bridges, and fear of flying.

Social Anxiety Disorder (Social Phobia) is characterized by significant fear of social or performance situations where embarrassment may occur, and interferes with one’s functioning. Exposure to social situations and the anticipation of being in a social situation brings on an immediate anxiety response. One recognizes that the fear is excessive, and situations are avoided. If one is not able to avoid the social situation, they are endured with intense anxiety.

Panic disorder includes the presence of recurrent, unexpected panic attacks, which is a period of intense fear, and interferes with one’s functioning. This is followed by persistent concern about having another attack, otherwise known as anticipatory anxiety. Symptoms of a panic attack include:

• Palpitations, pounding heart, chest pain
• Sweating, chills or hot flushes
• Trembling or shaking
• Sensations of shortness of breath, choking
• Feeling dizzy, lightheaded, faint
• Fear of losing control, dying, going crazy

Obsessive Compulsive Disorder (OCD) is characterized by obsessions and compulsions, which interfere with functioning. Obsessions are recurrent, persistent, intrusive thoughts, impulses or images. Resisting the obsession escalates the anxiety. The compulsions serve to decrease the anxiety associated with the obsession. Compulsive (repetitive) behaviors and/or mental acts include:

• Hand washing
• Checking
• Ordering
• Counting

One recognizes that the obsessions and compulsions are unreasonable, but it is easier to give in to the intrusive thoughts or execute the compulsive behaviors than tolerate the anxiety.

Post Traumatic Stress Disorder (PTSD) is characterized by exposure to a traumatic event that involves actual or threatened serious injury or death. The traumatic experience produced intense fear and helplessness. Later, one may experience:

• Flashbacks, nightmares of the traumatic event
• Feelings of detachment
• Feelings of guilt
• Sleep problems and other physical symptoms
• Avoiding anything associated with the traumatic event
• Heightened awareness, easily startled