How to know if you have an anxiety disorder, and what to do about it
Approximately 40 million adults in the U.S., which is about 18.1% of the population aged 18 and older, are affected by an anxiety disorder each year.
Anxiety is a universal experience. It's a natural emotional response to stress, and it can be beneficial in certain situations. For instance, it may alert us to danger or help us focus on important tasks, like studying for an exam or meeting a deadline. However, when anxiety becomes overwhelming or persistent, it may signal an anxiety disorder. While every person will experience anxiety throughout their lives, approximately 40 million adults in the U.S., which is about 18.1% of the population aged 18 and older, are affected by an anxiety disorder each year. Anxiety disorders are the most common mental health disorders in the United States, according to the Anxiety and Depression Association of America (ADAA). Despite being highly treatable, only about 36.9% of those suffering receive treatment. Understanding the difference between everyday anxiety and an anxiety disorder can help you learn how to best support your mental health.
What is Anxiety?
Anxiety is a feeling of worry, nervousness, or unease about an upcoming event or something with an uncertain outcome. It's a normal part of life and can be experienced by anyone. Common signs and symptoms of anxiety include:
Increased heart rate
Rapid breathing
Restlessness
Trouble concentrating
Irritability
Muscle tension
What is an Anxiety Disorder?
An anxiety disorder is a mental health condition characterized by excessive, persistent, and often irrational worry and fear. This intense anxiety can interfere with daily activities and can be difficult to control. Types of anxiety disorders include Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, and various phobia-related disorders. Symptoms of an anxiety disorder can be more severe and pervasive than those of everyday anxiety and may include:
Persistent worrying or obsession about small or large concerns that's out of proportion to the impact of the event
Inability to set aside or let go of a worry
Inability to relax, restlessness, and feeling keyed up or on edge
Difficulty concentrating, or the feeling that your mind "goes blank"
Physical symptoms such as fatigue, sweating, and gastrointestinal problems
Avoidance of situations that cause anxiety
Understanding the Anxiety-Avoidance Cycle
The anxiety-avoidance cycle is a common pattern of behavior that can maintain and even exacerbate anxiety disorders. This cycle involves a person experiencing anxiety, avoiding situations or activities that trigger their anxiety, and temporarily feeling relief. However, this avoidance reinforces their anxiety over time, leading to a persistent and potentially worsening problem.
The Cycle Explained
Trigger: The cycle begins with an anxiety-provoking situation or thought. This could be anything from social situations, specific places, or thoughts about the future.
Anxiety Response: In response to the trigger, the individual experiences anxiety symptoms. These can include physical symptoms (e.g., increased heart rate, sweating), cognitive symptoms (e.g., worry, fear), and behavioral symptoms (e.g., restlessness, irritability).
Avoidance Behavior: To reduce the uncomfortable feelings of anxiety, the person avoids the trigger. This could mean not attending social events, avoiding certain places, or distracting themselves from anxious thoughts.
Temporary Relief: Avoidance provides temporary relief from anxiety. This relief reinforces the avoidance behavior, making it more likely that the person will continue to avoid anxiety-provoking situations in the future.
Long-Term Consequences: Over time, avoidance can lead to increased anxiety and a decrease in the person’s ability to cope with anxiety-provoking situations. This can result in a reduced quality of life, as the person may miss out on important or enjoyable activities, and their world may become increasingly restricted.
Let’s consider the following example. An individual is invited to a party, but due to social anxiety, they experience fear of saying the wrong thing and being judged. They started to experience sweaty palms and racing thoughts just anticipating the event. To experience relief of these symptoms, they decide to not go, thereby relieving them of their anxiety symptoms. Over time, they start avoiding more social situations, leading to increased isolation and worsening anxiety. Because of their avoidance, their fear is never challenged and it keeps them stuck in a state of panic when these situations come up.
Breaking the anxiety-avoidance cycle involves addressing the avoidance behavior and learning to face anxiety-provoking situations. Here are some strategies:
Gradual Exposure: Gradual exposure to the feared situation or thought can help desensitize the individual to the anxiety trigger. This process, known as exposure therapy, involves starting with less anxiety-provoking situations and gradually working up to more challenging ones.
Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and challenge irrational thoughts and beliefs that contribute to their anxiety. By changing their thinking patterns, individuals can reduce their anxiety and improve their coping skills.
Acceptance and Commitment Therapy (ACT): At its core, ACT encourages individuals to embrace their thoughts and feelings rather than fighting against them, fostering a mindset of acceptance and commitment to positive change.
Develop Coping Strategies: Learning and practicing coping strategies, such as mindfulness, relaxation techniques, and problem-solving skills, can help manage anxiety symptoms more effectively.
The anxiety-avoidance cycle can be a challenging pattern to break, but with the right strategies and support, individuals can learn to face their anxiety triggers and reduce avoidance behaviors. By doing so, they can improve their quality of life and better manage their anxiety.
For further reading and resources on anxiety and its management, here are some research articles:
Every Day Skills to Manage Anxiety:
Practice Mindfulness and Relaxation Techniques: Techniques such as deep breathing, progressive muscle relaxation, and mindfulness meditation can help calm the mind and body.
Healthy Habits: Adopt healthy habits such as regular exercise, a balanced diet, and good sleep hygiene to help manage anxiety more effectively.
Establish a Routine: Having a structured daily routine can provide a sense of normalcy and build in preventative selfcare practices.
Limit Caffeine and Alcohol: These substances can increase alertness and energy levels but also has several effects that can worsen anxiety symptoms:
Increased Heart Rate and Blood Pressure: Caffeine and alcohol stimulate the central nervous system, leading to increased heart rate and blood pressure, which can mimic or trigger anxiety symptoms such as palpitations and nervousness.
Increased Stress Hormones: Caffeine and alcohol can increase the production of cortisol and adrenaline, hormones associated with the body's stress response, which can heighten feelings of anxiety.
Sleep Disruption: These substances interfere with sleep patterns, leading to insomnia or poor-quality sleep, thereby impacting the ability to regulate emotions.
Rebound Anxiety: Although alcohol may temporarily reduce anxiety, it can lead to rebound anxiety once its effects wear off. This can create a cycle of dependence, where individuals use alcohol to cope with anxiety but ultimately experience increased anxiety as a result.
While everyday anxiety can be managed with lifestyle changes and coping strategies, an anxiety disorder often requires professional intervention. If you or someone you know is struggling with anxiety that feels overwhelming or unmanageable, seeking help from a mental health professional is a crucial step toward recovery and well-being. Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) have shown to be effective for many people with anxiety disorders. A therapist can help you understand and manage your anxiety through learning your anxiety triggers, developing coping skills, and processing emotions. In some cases, medication such as antidepressants or anti-anxiety drugs may be prescribed to help manage symptoms. As mentioned before, anxiety disorders are the most common psychological disorder and one of the most treatable. Don’t wait to get help.
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References
1. Antony, M. M., & Stein, M. B. (2009). Oxford Handbook of Anxiety and Related Disorders. Oxford University Press.
2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
3. Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93-107. doi:10.31887/DCNS.2017.19.2/bbandelow
4. Craske, M. G., & Barlow, D. H. (2008). Mastery of Your Anxiety and Panic: Workbook. Oxford University Press.
5. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440. doi:10.1007/s10608-012-9476-1
6. Hofmann, S. G., & Smits, J. A. J. (2008). Cognitive-Behavioral Therapy for Adult Anxiety Disorders: A Meta-Analysis of Randomized Placebo-Controlled Trials. The Journal of Clinical Psychiatry, 69(4), 621-632. doi:10.4088/JCP.v69n0415