Anxiety disorders: symptoms, causes and management

Anxiety is a common feeling, especially before significant events – maybe you’re nervous about a job interview or uneasy during a first date? But these feelings are one-offs and fade with time. Anxiety becomes a concern when it is persistent and debilitating.

That may be a sign of an anxiety disorder.

Over 70 million people worldwide suffer from a clinical anxiety condition. [1] There are different support systems available to those with anxiety, starting from when symptoms manifest up to and beyond a diagnosis. 

Mental health is a crucial global issue. This makes it essential to discuss what anxiety is about, what its symptoms are and how you can manage your anxiety.

What is an anxiety disorder?

Stress can usually cause anxiety in certain situations, such as present danger or significant life events. Alternatively, anxiety can come from the nervous anticipation of an upcoming event or occurrence. Both of these are short-term emotional reactions that will dissipate once the trigger is eliminated.

Anxiety disorders, however, are medical conditions involving intense, persistent feelings of anxiety over prolonged periods of time. The feeling of anxiety is uncontrollable and excessive and may not be entirely logical. For anxiety to be considered a disorder, it should be:

  • Intense and overwhelming
  • Potentially irrational compared to the situation
  • Debilitating to daily life

To put it simply: an anxiety disorder is an excessive feeling of fear or nervousness that interferes with your ability to function. This anxiety can persist over days to months to even years. [2]

Types of anxiety disorders

Anxiety has many triggers, and so there are several types of anxiety disorders. These are generally classified by triggers or manifestations. [3

  • Generalised anxiety

Generalised anxiety disorder (GAD) consists of a persistent feeling of anxiety that interferes with day-to-day functioning. This anxiety goes beyond simple worry about experiences or events and persists over a long period of time. There is usually no specific trigger, but rather a general sense of anxiety regarding life.

People suffering from GAD act restless and on-edge, become easily fatigued, have difficulty concentrating and find it troubling to sleep.

  • Social anxiety

Social anxiety disorder involves an intense and persistent feeling of anxiety regarding social situations or interactions with other people. Often, people with social anxiety fear being judged or perceived by their peers. This fear is uncontrollable and hinders social activities, including going to school or attending an event.

Persons with social anxiety may have difficulty making or retaining eye contact, feel self-conscious around other people and have poor body language.

  • Phobia

A phobia involves intense aversion or fear of a specific situation or object. Arachnophobia is one common example, meaning an intense fear of spiders. Acrophobia is a fear of heights, while claustrophobia is a fear of small, enclosed spaces.

While it may seem realistic to be fearful in certain situations or around certain objects, a phobia is an extreme and uncontrollable response that is disproportional to the experience at hand.

Those who experience phobias may excessively worry about encountering the subject of their phobia and actively attempt to avoid it. They will also experience overwhelming anxiety symptoms if they do encounter their feared object or situation.

  • Panic disorder

Those who suffer from a panic disorder experience frequent, unexpected panic attacks – sudden, intense fear. There’s a sense of a loss of control, whether the panic attack is triggered or not. There is also anxiety over when the next attack will occur, or what will trigger it.

People may experience a panic attack in their lives, but it is not a disorder unless the panic attacks are reoccuring and regular.

Symptoms of a panic attack include a pounding heartbeat, sweating, shaking or trembling and feeling dread.

  • Other associated conditions

Anxiety may be comorbid with other psychosocial conditions, meaning it is present alongside or due to another psychological disorder in a person. [4] Some examples of conditions comorbid to anxiety are:

  • Obsessive-compulsive disorder (OCD)
  • Depression
  • Post-traumatic stress disorder (PTSD)
  • Bipolar disorder (BPD)
  • Attention-deficit hyperactive disorder (ADHD)
  • Autism
  • Eating disorders
  • Substance abuse

Causes of anxiety disorder

Like many other psychosocial disorders, anxiety is a clinical condition. This means that it is either inherent or triggered by a chemical or environmental cause. Anxiety does not come from personal flaws or weaknesses, but rather from a factor outside our control.

Scientists and researchers still cannot pinpoint the exact cause of clinical anxiety, but there are several factors involved.

Chemical imbalances

Persistent and exacerbated stress can cause a chemical imbalance in our brains. In particular, it affects the gamma-aminobutyric acid (GABA) neurotransmitter, which influences the way your brain stores and processes emotional information. Stress also affects other neurotransmitters such as oxytocin and endocannabinoids, which influence your emotional reactions. [5]

Genetics

Anxiety disorders are hereditary, meaning you can inherit a clinical anxiety condition such as GAD if there is present family history. For GAD, in particular, there is a 30% risk of inheriting the condition from either parent. More generally, there is a moderate risk of inheriting an anxiety disorder. [6]

External environment or situation

Experiencing a traumatic situation or event may cause someone to develop anxiety as a post-traumatic condition. Their anxiety may range from generalised nervousness to recurring panic attacks, particularly due to triggers associated with the trauma. 

Persons with trauma-related anxiety often resort to avoidance in order to prevent or mitigate the anxiety they feel. This is a naturally reinforcing action since avoidance reduces the chances of anxiety being triggered, but may not be a healthy coping mechanism in terms of recovery. [7]

Symptoms of anxiety disorder

Your anxiety may manifest in a variety of symptoms depending on the type of disorder you have. But some general symptoms are common across all anxiety disorders, or are more common than others. [8]

Physical symptoms of anxiety

Anxiety can manifest physiologically in ways such as:

  • Shortness of breath or difficulty breathing
  • Heart palpitations
  • Nausea or stomachache
  • Clammy or cold hands
  • Tension in your body
  • Tight chest

Mental and emotional symptoms of anxiety

As anxiety is a clinical psychosocial condition, there are several mental and emotional symptoms such as:

  • Intense feelings of dread, fear and unease
  • Intrusive or obsessive thoughts
  • Flashbacks to traumatic experiences or triggers
  • Nightmares
  • Uncontrollable panic
  • Inability to calm down or think rationally

Behavioural symptoms of anxiety

Besides the physical manifestation of symptoms in the moment that anxiety gets triggered, a person may also exhibit behaviours that suggest a chronic disorder.

  • Fidgeting
  • Constantly getting up to walk around without reason
  • Repeated questions or clarifications
  • Ritualistic actions, such as washing hands or counting items
  • Sleep disorders
  • Fiddling with items
  • Constantly fixing or rearranging spaces

Diagnosing anxiety

Diagnosing anxiety isn’t a straightforward procedure – far from it. Doctors can’t just run a blood test or a scan and figure out what type of anxiety a person has. Instead, patients must undergo rigorous and thorough testing to determine whether their anxiety is clinical and what type of treatment it requires.

Usually, your healthcare provider or general practitioner may recommend some physical exams first to rule out any physiological conditions that may be causing your symptoms. Some medical conditions that have similar symptoms include:

  • Cardiovascular conditions
  • Asthma
  • Menopause
  • Hyperthyroidism
  • Side effects of prescription medication
  • Withdrawal from prescription medication
  • Substance abuse

If your doctor has ruled out physical causes, they will refer you to a psychiatrist or psychologist. The psychiatrist will then have you undergo some psychiatric tests and interviews structured to determine whether your anxiety is persistent, intense and debilitating. Some tests used in assessing anxiety include the:

  • Hamilton Anxiety Scale
  • Beck Anxiety Inventory
  • Penn State Worry Questionnaire
  • Generalised Anxiety Disorder Scale

It may also emerge that your anxiety is comorbid to certain conditions, such as ADHD or BPD. In this case, you may not explicitly have an anxiety disorder, but rather anxiety as an effect or a symptom of an overarching psychiatric condition. This will affect your clinical diagnosis and subsequent treatment. 

Based on your diagnosis, your psychiatrist or psychologist will construct a treatment plan and recommend lifestyle changes or additions. They may prescribe medication, which you should take according to dosage. Anti-anxiety medication is most effective when taken at the same time everyday. [9]

Managing your anxiety disorder

If you suffer symptoms of anxiety or have a clinical diagnosis, there are actions and steps you can take to help manage your anxiety. These are physical and mental activities that can help mitigate the feeling of nervousness. You can also seek medical help. [10] [11]

#1 – Self-coping mechanisms

These are actions you can take by yourself to regulate an anxiety or panic attack. They involve changes or additions to your lifestyle in order to help you cope, such as:

  • Practising yoga
  • Meditation
  • White noise apps or machines
  • Calming exercises such as deep breaths or counting to 10
  • Hobbies such as painting or knitting that involve soothing, repetitive motions
  • Sitting in the sun for 15 minutes
  • Healthy and nutritious diet

#2 – Moderate exercise

A short or long walk can help calm you down and clear your head, but that’s not the only type of exercise you can do. Even moderate amounts of fitness can be a big boost to your health.

Start with small, daily goals such as a 15-minute walk or a 30-minute yoga class. You can work your way up from once or twice a week to 5 times a week. 150 minutes per week ist he recommended amount of exercise for good personal health. 

If attending a class or going outside causes you anxiety, you can find ways to exercise indoors! Follow along with YouTube workout videos or invest in an exercise machine like a treadmill. You can even plan a simple home workout to follow – just make sure you stick to it!

#3 – Good sleep

Sleep is essential to rest and recovery, all the more so when your brain has been on-edge and stressed the entire day. Practise good sleep hygiene by trying to follow the same bedtimes and wake-up times, so that you can regulate your circadian rhythm. This helps you fall asleep and wake up easier, too.

Clean your bedsheets regularly (at least once a week or once every two weeks) and have a comfortable mattress. Sleep in a dark room so that the light doesn’t interfere with your sleep.

#4 – Less caffeine

Caffeine is a stimulant and the last thing you need when you’re anxious is more stimulation. Limit your caffeine if you can’t eliminate it entirely. Try to go for tea, which has less caffeine than coffee. Green tea has plenty of health benefits and a low amount of caffeine.

Speaking of tea, chamomile has calming attributes – try a nice, hot cup of tea when you’re feeling distressed.

#5 – Medication

There’s a stigma in society surrounding medication for psychosocial disorders, but know that there’s no shame in taking prescriptions to help manage your anxiety. Sometimes, self-coping mechanisms and lifestyle adjustments alone are not enough to mitigate the symptoms.

Medications such as clonazepam, lorazepam and diazepam help manage anxiety. These fall under a drug class called “benzodiazepines,” which enhance the effect of GABA and counter the feeling of overstimulation. This can reduce the feelings of anxiety.

#6 – Psychiatric help

One effective treatment in conjunction with medication and self-coping mechanisms is therapy. There are different forms of therapy, from one-on-one consultations to desensitisation and exposure. This works by slow, controlled exposure in a safe environment, with someone coaching you to address your source of anxiety.

The goal of therapy is to engage you into a supportive mindset, not a reactive one, and to help you adjust your behaviours and treatments so that you maximise their benefits.

#7 – Support groups

Sometimes, having people around who know and understand your disorder can help immensely with the feelings of anxiety and dread. Support groups consist of people who share the same experience, such as trauma or anxiety. You can feel more connected this way, and social connections have shown to benefit our personal health.

Check your local neighbourhood or city to see if there are anxiety support groups or foundations available.

Living with anxiety

There are millions of people living with anxiety disorders, all over the world. These disorders may be caused by genetics, external stressors, or traumatic events. Anxiety manifests in different ways, with a variety of symptoms. You may not experience all these symptoms, or may have more uncommon ones.

The condition may interfere with your everyday life and cause you distress, but you can manage and mitigate it with proper treatment. Exercise regularly, sleep and eat well, take your medication regularly and be open with your therapist. And of course, take care of yourself! It’s essential not to push yourself too hard or you could exacerbate your condition, making things worse in the long run.

Living with anxiety isn’t easy, but it is manageable. There’s no be-all, end-all “cure” for anxiety and it’s important to accept that. Instead, focus on managing your condition and minimising the effects of your symptoms. This, alongside a healthy lifestyle, can go a long way towards making living with anxiety a less terrifying prospect.

REFERENCES

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02143-7/fulltext
[2] https://psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
[3] https://www.nimh.nih.gov/health/topics/anxiety-disorders
[4] https://adaa.org/understanding-anxiety/co-occurring-disorders
[5] https://www.medicalnewstoday.com/articles/326475#what-conditions-are-linked-to-chemical-imbalances
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573560/
[7] https://adaa.org/understanding-anxiety/trauma
[8] https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders
[9] https://www.healthline.com/health/anxiety-diagnosis
[10] https://adaa.org/tips
[11] https://www.mhanational.org/conditions/anxiety

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