Anxiety

Experiencing fear, stress or worry at some time is common. In some instances, the feeling persists for long. In almost all cases, it is triggered by a stimulus which can be an event, a thing, or a person. However, when these feelings grow to such an extent that they begin to interfere with your daily functioning, it is termed as an anxiety disorder.

What is an anxiety disorder?

According to the American Psychological Association (APA), the anxiety disorder can be defined as ‘an emotion characterised by feelings of tension, thoughts of worry, and physical changes like increased blood pressure'. While normal feelings of anxiety only help develop coping mechanisms and give the person a chance to realise potential under pressure, anxiety disorders require medical attention.

While the concept of anxiety disorders may seem much generalised, there are, in fact, three categories under which the different conditions of anxiety can be discussed:

Anxiety disorders
The recurring theme of these disorders is an exaggerated fear which results in behavioural problems and disturbance in natural functioning. The different kinds of anxiety disorders are:

• Separation anxiety
  This form of anxiety is experienced by both adults and children when they think about being separated from a place or a person of significance. This condition can manifest in several forms including sleeplessness, fear of going to work or school, or anxiety of being alone. While it may be considered a reasonably natural emotion, those with separation anxiety experience academic or occupational difficulty.
• Selective mutism
  In this condition, a person finds himself/herself unable to speak on certain occasions. This inability to speak has nothing to do with being unaware of the situation or topic but is persistent in certain circumstances.
• Specific Phobia
  A pronounced fear or phobia about a particular place, experience or thing which persists over a period qualifies as a specific phobia.
• Social anxiety
  This is the fear of feeling awkward or embarrassed in facing social situations, which leads to the person’s withdrawal from social scenarios.
• Panic disorder
  This form of disorder occurs when the person feels a sudden sense of panic and begins to fear the onset of the panic situation itself. Tell-tale signs include increased heart rate (tachycardia), dizziness, sweating, and numbness.
• Agoraphobia
  This fear exists when people are afraid that they will not find help when faced with a panic situation.
• Generalised anxiety
  People with this kind of disorder are just worried in general, mostly about events and adverse outcomes.
• Obsessive-Compulsive and Related Disorders
  In this form of the disorder, the person has a constant preoccupation with individual thoughts, which start interfering with other ongoing tasks, activities and thought processes. As a result, a trigger in behaviour is observed which is a natural outcome and is generally done to take the mind off the anxiety surrounding the obsession. A consequence of this form of anxiety could be impaired involvement and restricted behaviour.
  An obsession or constant thought leads to compulsive or repetitive behaviour. The person holds a belief that failure to perform the repetitive task will result in harm or damage. Common OCDs (obsessive-compulsive disorders) include preoccupation with germs, precision, or presenting things in a specific rigid manner.
• Excoriations
  This is the tendency to keep picking at one’s skin which may result in lesions and scabs.
• Hoarding disorder
  This can exist in two forms, presenting either together or individually. In one, the person has great difficulty letting go of things accumulated, no matter how useless or battered they may be. The other form causes anxiety of not being able to gather and collect items for oneself.
• Body Dysmorphic Disorder
  This is a general perception of being unattractive and ill-formed.
• Trichotillomania
  In this disorder, a person has an uncontrolled obsession of pulling of hair from eyelashes and eyebrows, or the scalp.
• Trauma and Stress-Related Anxiety
  These forms are generally focussed around a stressor or a traumatic experience.
• Post-Traumatic Stress Disorder (PTSD)
  A series of symptoms exhibited as a result of a traumatic experience, which typically disturbs daily functioning is known as a post-traumatic stress disorder.
• Acute Stress Disorder
  A range of different symptoms that are experienced in great degrees following a traumatic experience, the most pronounced of them being anxiety around experiencing the same symptoms again.
• Adjustment disorder
  Development of specific symptoms which arise from a stressful event, like divorce, death or relocation.

Anxiety cannot be described in stages, but more regarding the levels at which it is experienced. Some are capable of managing their anxiety using their coping mechanisms, while others may require professional help to address their anxiety issues.

• Mild anxiety
  At this stage, you may feel some minor symptoms including sweatiness and irritability. However, you are still alert and are capable of handling the situation and looking for possible solutions to the case. This condition is a typical experience in stressful situations.
• Moderate anxiety
  At this stage of the disorder, your heartbeat is increased, the mouth runs dry, and you may feel a stomach ache or nausea. Symptoms subside once the situation is overcome.
• Severe anxiety
  Vomiting, diarrhoea, trembling and erratic behaviour are typical of this stage. Objectivity and problem-solving capacities are affected, and it is difficult for the person to find the best solution to the situation.
• Panic level anxiety
  At this level, the person is unable to think, speak or move. This problem is most common when the stressors are extreme.

There is a wide array of symptoms that can be experienced in anxiety disorders. After all, there are so many different kinds of complications, and each one is of a very different nature. The most generic symptoms of anxiety disorders across the different types include sleep disturbances, palpitations, breathlessness, fidgeting, tingling in the hands and feet, sweatiness, giddiness and nausea, and rigidity and tenseness in the muscles.

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It is most commonly believed that life events contribute to the experience of anxiety disorders. However, there may be some other factors that can cause anxiety disorders, or place a specified population at higher risk.

Causes

The common causes include:

• Medical problems
  Medical problems may cause anxiety disorders in some people. Especially in people with specific severe or chronic ailments, the prevalence of anxiety disorders may be higher. Medical illnesses that could lead to anxiety are respiratory disorders, thyroid, heart ailments, tumours, and irritable bowel syndrome.
• Drugs and alcohol
  People who misuse drugs and alcohol are also among those who are likely to experience anxiety disorders. This attitude is even a possible experience among those who are recovering from the addiction or facing withdrawal symptoms.

In some people, anxiety may not be caused due to a medical condition itself but maybe the side effect of a particular medication prescribed in treating medical problems.

Risk factors

The risk of anxiety is higher among some people, especially those who have:

• Been through a traumatic event in their life, regardless of what stage of life. It can also be experienced by those who have witnessed a traumatic event but haven’t necessarily experienced it.
• Experienced a combination of several stressors that can lead to the build-up of anxiety.
• Other related mental disorders like depression.
• Abusers of alcohol and/or drugs.
• A family history of anxiety disorders.
• Stress that accompanies illnesses that are serious or chronic.
• A personality type that is easily predisposed to anxiety.

It is quite difficult to prevent anxiety since the discomfort and disturbance faced by the individual are genuine, especially those people in whom a traumatic experience is a trigger for an anxiety disorder, it is hard to prevent anxiety from being experienced. However, these pointers can help minimise its impact and also improve in managing other forms of anxiety effectively:

• A good diet and exercise regime.
• Meditation, yoga and relaxation programs.
• Adequate rest.
• A change of experience, perhaps in the form of a holiday.
• Resting for some time or days depending on the level of anxiety.
• Identifying stressors and being more prepared for the experience.
• Talking about the problem and developing communication skills.

In an event where a person experiences severe anxiety, he/she will need a psychological examination which will help in providing clarity on the symptoms being experienced, assessment of thoughts and feelings and also looks at the accompanying complications. The symptoms manifested will then be compared to a list of criteria listed in the DSM5 (Diagnostic and Statistical Manual of Mental Disorders) to check whether it qualifies as a case of anxiety disorder.

There are two main approaches to treat anxiety. The best results are usually seen when both are used in combination.

• Evidence-based therapies
  This form of therapy is also known as ‘Talk Therapy’ since it focuses on communicating with the patient and getting them to express their feelings.
  • Counselling
    This is a tool used to help people address and deal with specific problems like stress.
  • Psychotherapy
    Unlike counselling, which looks at immediate solutions to existing problems, psychotherapy is a more long-term approach which attempts at correcting patterns and recurring behaviour. The objective of psychotherapy is to enable people to manage emotions, relationships, and stress. There are various forms of psychotherapy. The most effective of those include Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT) and Prolonged Exposure Therapy (PE).
  • Family Therapy
    Anxiety is not a battle that can be fought individually. Family support in treating and managing anxiety is critical. The family forms a great support system for the person by helping him/her to understand and overcome the symptoms, along with communication and shaping better interpersonal relationships. Even in cases where the family itself is a reason for stress, family therapy is the most important course of treatment.
• Medication
  Apart from the ‘talk’ based approach, medication also comes up as a significant method for treating anxiety. Medicines are usually prescribed based on the symptoms displayed and the factors that are being addressed as a course of correction. Most medications are safe, although some minor side effects may be observed.
  • Anxiolytic drugs
    These are the most common medication for generalized anxiety disorder. These are safe drugs which help address cognitive issues surrounding anxiety. They can be safely administered as they do not interfere with alcohol and do not create dependency. They can, however, cause headaches, nausea, and dizziness.
  • Benzodiazepines
    These medicines have a more short-term course and may be used to suppress acute anxiety. These drugs can address sleep disturbances, withdrawal symptoms of alcohol and even epilepsy. These drugs have side effects and are not ideal for prolonged use since they are sedative and can also result in dependency.
  • Beta-blockers
    They are prescribed to increase the flow of blood, decrease blood pressure and lower the force of contraction in the heart muscles, thereby reducing palpitation and tremors of the heart. However, these are the only conditions that can be addressed, and the medication does nothing to help phobias or panic attacks.
  • Antidepressants
    Antidepressants may sometimes be prescribed to treat specific symptoms in anxiety disorders.
• Alternative treatments like meditation, exercise, acupuncture, and neurostimulation may also be advised along with the regular course of treatments.

Lifestyle management

Managing anxiety may require making some significant changes in lifestyle. Here are some tips that you can follow:

• Eliminate caffeine from the diet. It is known to be mood altering and may worsen the anxiety.
• Cut down on excessive sugar and chocolates.
• Opt for an active lifestyle including plenty of outdoor exercises. Exercising helps release chemicals in the body (endorphins) that elevate the mood and make you feel more positive.
• Forming a more disciplined, regimented lifestyle can help you feel a greater sense of control and also help in minimising your stress levels. Since anxiety is almost always accompanied by insomnia (sleeplessness), forming a routine will also ensure adequate rest and sleep.
• Never take any medication without consulting the doctor. Even seemingly harmless natural or herbal medicines can interfere with the condition and worsen anxiety levels.
• Follow through the course of treatment and do not give up mid-way.
• Form support groups and find friends. Avoid being alone. People are more prone to anxiety and panic attacks when left by themselves. Joining a support group for anxiety will help you share, realise you are not alone and provide insights on how you can cope.

Prognosis

Anxiety disorder is a chronic condition where the chances of relapse are very high. It is indispensable that the complete course of treatment is followed diligently to ensure that all signs of the condition are addressed. Upon completion, a careful watch must be kept to ensure the symptoms do not reoccur. Management of anxiety is vital in ensuring the sustained well-being of the patient in the long run. If symptoms do appear on completion of treatment, medication might resume. Alternatively, some short-term medicines may be provided to suppress the problem immediately.

Complications

Anxiety can hamper functioning at three levels:

• Physiological
  Anxiety and its related problems can cause the following, or make the conditions worse.
  • Digestive and bowel related ailments.
  • Chronic ailments.
  • Insomnia.
  • Heart-related problems.
  • Severe headaches.
• Behavioural
  • Lack of energy and inclination to perform tasks.
  • Lack of attentiveness.
  • Impaired ability to function optimally.
  • Greater likelihood of depression.
• Mental Health
  • Panic.
  • Suicidal tendency.
  • A possibility of substance abuse.
  • Obsessive-compulsive disorder.
  • Phobias.
  • Post-traumatic stress disorder.