Anxiety is a normal feeling that people have when they are faced with something that could be dangerous or difficult, embarrassing or stressful. Exams, job interviews, talking in front of a group, learning a new skill (such as driving), all make people feel anxious. The feelings of anxiety can include feeling upset, tense and uncomfortable. Your pulse rate might go up, you may have a disturbing feeling in your tummy (”butterflies” in the tummy) and you could feel sweaty. Feeling anxious at these times is normal, and the feelings usually go away after a short time, when the task or the stress has finished. For people with an anxiety disorder the feelings are there much of the time, and they interfere with normal life.
This topic gives an overview of anxiety disorders. It gives some practical suggestions and information about health and illness. It is important to see your doctor if you are worried about your health as information about a particular problem may not exactly fit your situation.
WHAT ARE ANXIETY DISORDERS?
Anxiety disorders are when anxious feelings are present much of the time, even when there is no obvious cause for them. A person may be continually uncomfortable and tense. Anxiety disorders are likely to be diagnosed when the anxiety and feelings of panic get in the way of normal life and stop people doing what they want to do.
The feelings that go with high levels of anxiety are divided into several different patterns or ”types” of anxiety disorder. A diagnosis of one of the types of disorder can help work out the most useful way of trying to manage the anxiety.
GENERALISED ANXIETY DISORDER
The main symptom of this disorder is excessive and persistent worry, causing feelings of being keyed up all the time, being easily tired, having difficulty concentrating, irritability, muscle tension and sleep problems. Young people may worry about school or sport performance, such as exams, so much that they are not able to do well.
People with this pattern of feelings experience great anxiety (panic) in situations where most people would not be afraid. They can have many physical symptoms such as feeling faint or dizzy, blushing, rapid heart rate, difficulty breathing, sweating, abdominal pain (and acute diarrhoea), chest pain. With this goes a fear that the attack will lead to them dying or totally losing control. When the panic has gone, there is an ongoing fear that the panic will come back. Fear of panic can lead them to stop doing things that might trigger a panic attack, such as going outside or going to certain places where they have had a panic attack. Young people who get panic attacks may have had trouble with fear when they were away from their parents when they were younger (separation anxiety).
Agoraphobia is fear of getting a panic attack if you are somewhere from which it might be difficult or embarrassing to get away. It is the most common type of anxiety disorder. Some places that people who experience agoraphobia are worried about are crowded places, lifts and public transport. People with agoraphobia avoid going places because they might have a panic attack.
SEPARATION ANXIETY DISORDER
This type of anxiety disorder is more of a problem for children and younger people. They may feel extremely distressed when left at school or kindy. Sometimes they feel very scared that someone close to them (like their parent) might leave or be killed in a car accident or murdered or kidnapped. They may show their anxiety by crying and clinging or physical symptoms such as tummy pain, and they often have nightmares about separation.
Phobias are intense fears about things or situations that then interfere with life. Most people are fearful about some things (such as spiders and snakes) or new activities such as starting a new job. Someone who has a phobia about some thing (such as a spider) will feel fine when there are no spiders, but they can become extremely distressed and may have a panic attack when they see a spider. Fear of having a panic attack might then stop them from doing anything where they might see a spider.
People with social phobia fear that other people will judge everything that they do negatively so that they either try to make sure that everything that they do in front of someone else is perfect (limiting what they can do) or they avoid contact with others.
Young people with social phobia may refuse to go to school or to talk with people of the opposite sex.
Young people with this disorder have constant unwanted thoughts which they try to suppress, or they have to perform rituals (putting things straight, washing, checking locks etc) to control the thoughts. The rituals usually take a lot of time and they interfere with everyday life. People with obsessive-compulsive disorder are often really embarrassed by their disorder and try to keep it a secret even from their families.
POST-TRAUMATIC STRESS DISORDER
People who have experienced a major trauma such as war, motor vehicle accident, torture or personal violence such as rape may continue to feel extreme fear long after the event happened. They may have distressing memories that keep coming back, dreams, flashbacks or fear triggered by something that reminds them of the event. They may feel better when they avoid things that remind them of what happened, but this can restrict their lives and interfere with interpersonal relationships. They may be irritable, have trouble with sleeping, have outbursts of anger, be overly aware of things around them. If these symptoms go on for over a month then they may be diagnosed as having post-traumatic stress disorder.
WHAT CAUSES ANXIETY DISORDERS?
The causes vary from person to person, and it is not always easy to be certain what has led to the difficulty for each person. Some things that are known to contribute to whether a person has an anxiety disorder.
- Heredity: anxiety disorders tend to ”run in families” which may be due to genetics, and may be because a child learns anxious behaviours from their family.
- Personality: people who are easily upset, very sensitive and emotional, who are shy and inhibited as children are more likely to develop an anxiety disorder.
- Biochemical differences within the brain may play a part.
WHAT TO DO IF YOU THINK YOU MAY HAVE AN ANXIETY DISORDER
Often people who have an anxiety disorder are very reluctant to seek help because they are very embarrassed by the feelings that they have and do not want to admit them to others. They may feel that they will be judged as unworthy. They may not have developed good skills at talking about their feelings because they have been shy or have avoided being with others.
Seeking and accepting help can make a lot of difference. You could go to your doctor, community health centre or community mental health service.
Learning more about anxiety disorders can give you greater understanding, but this will probably not be enough to help you manage the feelings you have.
There are many different things that may be helpful.
- Cognitive behaviour therapy (learning new ways of interpreting feelings and different ways of thinking about behaviour), behaviour therapy (sometimes including desensitisation to the thing that triggers the panic) and family therapy may be useful depending on what the difficulties are.
- Changes in the environment, such as changes at school, may be helpful.
- Sometimes medication can make a difference, but some medications such as the benzodiazepines (Valium type drugs), which lower anxious feelings without looking at what is going on underneath the behaviour may not be helpful in the long run. Antidepressant medications may be useful.
- Relaxation techniques, exercise, doing things which you enjoy will be helpful as extra things which help you understand your body and your feelings better.
WHAT TO DO IF YOU THINK YOUR FRIEND MAY HAVE AN ANXIETY DISORDER.
- Remember that your friend cannot just choose to be less anxious. Saying things like ”Don”t worry so much”, and ”you don”t have to be perfect” will not be useful.
- Encourage your friend to accept that this is a form of illness and that they have a right to seek help just as they would for other illnesses such as asthma or a broken bone.