Anxiety

Everyone feels anxious sometimes. In fact, feeling fear is a good thing. It would be dangerous if we didn't feel fear. Fear is the emotion that drives us to stay safe. If a car is quickly moving towards us, fear is the emotion that gets us to quickly jump out of the way. We don't have to logically analyze if we should or should not jump out of the way of the car. We just jump. In many ways, the ability to feel fear is life-saving. However, what happens when we are afraid of things that are not inherently dangerous? Has anyone in the history of the world actually ever died of public speaking? I'm pretty sure not, however it is still the world's number one phobia.

Anxiety is the emotion we feel when we are anticipating that something bad or dangerous is going to happen to us or someone we care about. It is entirely Future-Oriented. Notice we can only feel anxious about events in the future. We can't feel anxious about things that have already occurred. We can feel ashamed or sad about the past, but we can't feel anxious about it.

Anxious thoughts often start with two words: "What If." We imagine a terrible scenario in the future that will be painful, embarrassing, or difficult. Anxious thoughts often have a pressured quality to them. When we are very anxious our thoughts might go fast, they might be kind of scattered or disjointed, and not very logical.

Anxiety feels painfully uncomfortable. We often feel it in our chest with a tight pressure sensation. We might notice a rapid heartbeat or that it is hard to breathe. We might notice we are breathing quickly (hyperventilating). We might feel restless like we have to walk or move around or pace. Our faces might feel hot. We might break out into a sweat. Our hands might be cold and clammy. The most intense kind of anxiety is called a panic attack, and when that happens, we feel like we are losing control or going crazy. During a panic attack we might feel dizzy or nauseous or like we might faint.

Although some amount of anxiety is normal for everyone, when anxiety is severe or it reaches a point that it is negatively impacting your wellbeing, or it is impacting your work or other areas of your life, it might be worth talking to your doctor about. There are several types of anxiety that are considered Anxiety Disorders.

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder, or GAD, is when we worry all the time, about anything and everything. We feel like we can't stop the worrying. It impacts us physically as well. It negatively impacts our sleep, making it hard for us to either fall asleep or stay asleep and can prevent us from feeling like we have had restorative sleep. It can cause jaw pain because we are constantly clenching our teeth. Maybe we feel pain in our neck and shoulders from constantly keeping our muscles tense. We might have a nervous stomach with stomach aches or symptoms of IBS. All of this physical tension can make us feel drained and exhausted. This can also make us irritable and cranky. We might notice that with all of these symptoms it is hard for us to focus or concentrate as well.

People with GAD often suffer in silence. They usually feel embarrassed about how nervous they are. They wish they could just relax and take it easy like they see other people doing but they just don't know how. Oftentimes one of their parents was an anxious person too.

The best treatment for GAD is a combination of both medications and therapy. GAD is highly treatable! GAD also often comes along with depression. When we have been anxious for a long time, it gets pretty depressing. We feel hopeless that we will spend the rest of our lives feeling this way. Alternatively, if we have experienced depression for a long time, we can become highly anxious that we will never feel better as well.

A great first step is to talk to your doctor about your symptoms. You might feel a little embarrassed but don't be! Nearly 7 million people in the U.S. have GAD and twice as many women as men are likely to have GAD (Anxiety and Depression Association of America) You can feel better! Many of the medications for anxiety are the same ones that are used for depression. So often you can treat both conditions at the same time. But please consider therapy. Therapy is absolutely crucial for treating anxiety. Medication alone will not be sufficient to manage your symptoms. As much as we would like to think we can take a pill and make it all go away, anxiety is as much about how you are thinking and living your life as anything else, and only therapy can address that.

Panic Disorder

Panic Disorder is when a person has repeated panic attacks and a chronic fear that they will have another panic attack. So what exactly is a panic attack?

A panic attack is an abrupt surge of intense fear accompanied by at least four of the following: heart palpitations, sweating, shaking, shortness of breath, feeling of choking, chest pain, nausea or abdominal distress, dizziness, lightheadedness or feeling like you might faint, derealization (feelings of unreality) or depersonalization (being detached from oneself), fear of losing control or "going crazy", fear of dying, numbness or tingling sensations, chills or hot flashes.

Panic attacks are just awful. I had my first one in college and I literally thought I was going to die. In fact, many people when they have their first panic attack believe they are having a heart attack and end up in the emergency room.

Without treatment for panic attacks, people can begin to develop the fear that they are going to have more panic attacks, so they start to avoid life, or situations that they worry will trigger a panic attack. If they begin to avoid leaving the house or living a full life because of their panic attacks, we call that Panic Disorder with Agoraphobia. This is an incredibly disabling condition which is also highly treatable. The thing to remember about all anxiety disorders, is that EXPOSURE is the key to healing. When we are anxious, our urge is to avoid what we are afraid of and this promotes more anxiety. In order to overcome anxiety, we have to move towards what we fear. Now we don't necessarily have to move towards it quickly and overwhelm ourselves, but we do have to face our fears nonetheless if we want to ultimately heal from anxiety. And yes, this is super hard. But with professional help and self-compassion, you can absolutely overcome anxiety.

Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder (PTSD) occurs when someone either experiences or witness a life threatening or violent event. There are four categories of symptoms that can occur when someone has PTSD.

The categories are: intrusion symptoms, avoidance symptoms, negative thoughts or beliefs and reactivity symptoms.

1. Intrusion symptoms can include: intrusive thoughts, nightmares, flashbacks, anxiety at memories or triggers of the event
2. Avoidance symptoms can include: trying not to think about the event, inability to recall aspects of the event, avoidance of situations that remind you of the event
3. Negative thoughts or mood can include: negative beliefs about yourself, others or the world, self-blame, chronic negative feelings such as horror, guilt or shame, lack of interest or enjoyment in things, difficulty connecting with or trusting others
4. Increased reactivity symptoms can include: anger outbursts, irritability, reckless or self-destructive behavior, increased startle response, hypervigilance, difficulties concentrating, impaired sleep

Another term that is often used clinically is Complex Post Traumatic Stress Disorder or C-PTSD. This is a term that is meant to convey that rather than witnessing or experiencing a one-time traumatic event, someone has experienced multiple events over months, years or decades. In addition to the symptoms shown in classic PTSD, individuals with C-PTSD also display behavioral difficulties (impulsivity, aggressiveness, sexual acting out, alcohol/drug misuse and self-destructive behaviors), emotional difficulties (emotional lability, rage, depression and panic), cognitive difficulties (dissociation and pathological changes in personal identity), interpersonal difficulties (chaotic personal relationships) and somatization (physical complaints and frequent visits to medical practitioners.)

There is much debate in the medical field at this time about the overlap of C-PTSD and Borderline Personality Disorder, a condition that is characterized by many of those symptoms described above. Continued research will need to be conducted to determine if these are the same condition or separate conditions with similar symptom profiles.

At this time we know that medications can provide help with emotional stabilization, however therapy is crucial to address many of these areas. One form of therapy that can be helpful is called Dialectical Behavior Therapy (DBT)

Social Anxiety Disorder

Social Anxiety Disorder is a real thing: A diagnosable mental health condition. If you have it, you know this is real. Social Anxiety Disorder is significant fear about being in social situations in which we might be exposed to possible scrutiny or judgment from others. Examples include: having a conversation, meeting unfamiliar people, being observed eating or drinking, or performing in front of others such as giving a speech. The fear is disproportionate to the situation. The person avoids the situation or endures it with much distress. Like, a ton of distress.

I see a lot of folks with Social Anxiety Disorder, and to be honest, the pandemic only worsened it for many people. Some of us who had mild social anxiety developed full blown Social Anxiety Disorder as a result of being at home for a long period of time and not being exposed to social situations. Remember: avoidance breeds anxiety; exposure heals anxiety.

Interestingly, men and women have equal rates of Social Anxiety Disorder and Social Anxiety Disorder is twice as common as Generalized Anxiety Disorder (Anxiety and Depression Association of America).

Like all anxiety disorders, Social Anxiety Disorder is best treated with medication and therapy. The more exposure you have to social situations the better. Consider joining a group like Toastmasters or another group that allows you to be in front of a larger group to give you more exposure opportunities.