What is Anxiety?
Anxiety is an emotion almost everyone feels from time to time.
It’s a sense of dread, of worry. Sometimes you can’t pinpoint exactly what’s wrong or what you fear, but it feels like you’re in some terrible unspecific danger. That’s one of the things that can be so pernicious about anxiety; you’re not entirely sure what the threat is, and you can never be sure the threat has passed.
Anxiety also creates physiological changes in your body such as racing heart, sweating, shaking hands, dry mouth. It can start affecting your breath, you can feel a tightness in your chest, a lump in your throat, a knot of dread in your stomach, even nausea. You can start feeling light-headed, like you’re about to pass out. You can start feeling really hot or feeling really cold. All your muscles can start feeling super tense, to the point that they may feel a bit achy or numb or tingly. With all this anxiety, it can feel very difficult to concentrate on whatever you’re doing or to fall asleep. This lack of sleep can make you fatigued or irritable.
Sometimes things may seem so out of the ordinary that the world doesn’t quite seem real or you don’t feel like yourself. You feel really restless, unable to relax. Your mind can be bombarded with unwanted thoughts, where you start thinking of the worst-case scenarios and blowing potential dangers out of proportion. These thoughts and bodily reactions can feed off of each other. As you get more tense physically, the more worrisome thoughts fill your mind, which makes you even more tense.
Some people experience anxiety frequently enough or intensely enough that it disrupts their lives and lead to some maladaptive behaviours. Such people are often diagnosed with anxiety disorders. According to the ICD-10, the latest version of the International Statistical Classification of Diseases and Related Health Problems manual, there are three main types of anxiety disorders: phobic anxiety disorders, panic disorder, and generalized anxiety disorder (GAD). Anxiety can also be a symptom or an underlying issue in other disorders such as post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD). I’ll explain each of these in turn.
Phobic anxiety disorders, are a cluster of different disorders where people are afraid of a certain situation or object. For instance, people may be afraid of heights (acrophobia), or open spaces (agoraphobia), or embarrassing social situations (social phobia). These fears can make people with these disorders go out of their way to avoid what they’re afraid of, which can hinder or limit their daily lives. Panic disorder is when a person experiences multiple panic attacks, which is very intense bursts of severe anxiety. These episodes can be very scary and someone with a panic disorder may feel anxiety about when the next panic attack will be.
Generalized anxiety disorder (GAD) is feeling excessively anxious constantly for long periods of time, at least 6 months to warrant a diagnosis. For people with GAD, their anxiety feels out of their control. This can be so bad that people will completely avoid getting in situations that may cause them anxiety, which can include avoiding going to work or out on social occasions. With post-traumatic stress disorder, someone who experienced an extremely stressful and traumatic event may become very anxious when reminded of the event. They may feel constantly on edge and their quality of life and ability to function can be severely impaired. In obsessive-compulsive disorder, someone who feels very anxious feels compelled to perform certain tasks in a ritualistic fashion to avoid the outcomes they are anxious about. For instance, someone who fears getting diseases may repeatedly wash their hands. Often, the ritual may be entirely unrelated to the fear. For example a person might feel compelled to count to a certain number so their loved ones don’t get hurt. With severe cases, these rituals can take so much time that it takes over their lives. Though I listed each anxiety disorder individually, people often have multiple diagnoses of mood disorders. In fact, people with an anxiety disorder are 3 to 5 times more likely to also have depression (2)
As with most mental disorders, anxiety disorders are caused by a combination of physical and psychological causes. Anxiety disorders are estimated to be the most common type of mental health disorder and approximately 14% of people in the EU have experienced it in the past year(3). Anxiety has a large genetic component and tends to run in families(4).
The emotions we feel are the result of different naturally produced chemicals in our bodies, including hormones and chemicals between our brain cells that help transmit information called neurotransmitters. We don’t yet understand the mechanisms behind anxiety, but medications which control neurotransmitter levels have been found to be very effective, especially when combined with psychotherapy(5).
One medical condition that causes anxiety and can be confused with an anxiety disorder is hyperthyrodism. This is when the thyroid is overactive and the hormones it produces disrupt the adrenal glands and the hormones it produces in turn, causing an increase in the ‘flight or fight’ response. Fight or flight is the basic instinct originally designed for animals and neanderthals, where the body starts to get ready for a potential danger with responses like raised heartbeat, and the urge to run or lash out. In reality there is no discernable danger, so the mind starts coming up with reasons to feel so anxious. A test for thyroid stimulating hormone (TSH) levels can rule out whether anxiety issues are being caused by thyroid problems.
Some people with anxiety start to ‘self-medicate’ with various substances such as alcohol, marijuana, or opioids to deal with their anxiety; 33% of people seeking treatment for alcohol use disorder and 43% of people seeking treatment for drug use disorder have an anxiety disorder. The alcohol or drugs make them stop feeling the anxiety for a short while, but usually, it makes the anxiety worse in the long run.
Every time you run away from anxiety rather than learn ways to deal with it, the anxiety gets worse. The more you avoid facing those feelings, the more powerful it becomes.
If you think you are suffering from an anxiety disorder the best thing to do is to speak to a mental health professional, whether it be a doctor, or a counsellor, or a psychologist.
The first step towards this could be calling the Music Support helpline. Please do.
In a future article, I will address some additional strategies to cope with anxiety, whether it reaches the level of a disorder or not.
Mariana Kishida is a researcher and community health educator who received her PhD in Psychology from King’s College London.
1. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 1992. http://apps.who.int/iris/handle/10665/37958. Accessed June 17, 2016.
2. Meier SM, Petersen L, Mattheisen M, Mors O, Mortensen PB, Laursen TM. Secondary depression in severe anxiety disorders: a population-based cohort study in Denmark. Lancet Psychiatry. 2015;2(6):515-523.
3. Wittchen H-U, Jacobi F, Rehm J, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21(9):655-679.
4. Hettema JM, Neale MC, Kendler KS. A review and meta-analysis of the genetic epidemiology of anxiety disorders. Am J Psychiatry. 2001. http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.158.10.1568. Accessed June 17, 2016.
5. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014;13(1):56-67. doi:10.1002/wps.20089.