Imagine that you are getting ready to go to a party but you get a sudden overwhelming feeling, like another heartbeat. You start worrying about who you should talk to when you reach there, what if no-one wants to talk to me? What if nobody likes me? You finally muster the courage to reach the party. Someone approaches you and starts talking to you but your mind is racing, your breathing is affected, you are sweating profusely and you can’t seem to even see straight. It almost feels like an “outer body experience”. You try to compose yourself, only to realise that there are so many people around you and your chest again goes into knots. Once the conversation ends, you feel completely drained. You start worrying about feeling this way again and to avoid the feeling like a near heart attack, completely abandon the situation and rush home. As you think about this more and more, you realise that this is not the first time that you have felt this constricting feeling. You also felt this, when you went to buy groceries the other day. When you were on a bus or even studying for an exam. You start feeling nauseous, restless and everything feels blurry. To avoid this from happening, you have abandoned even visiting some places entirely, you arrange your daily activities specifically around avoiding such situations. You have planned on how to reach safety when it does happen again and distract yourself to take your mind away from this nerve-wracking, near-death situation.
These feelings are characteristics of anxiety disorder. One of the most commonly found mental illnesses with about 284 million people suffering from some form of anxiety disorder. Anxiety is a negative mood state that is characterised by bodily symptoms of physical tension and by apprehension about the future. It is the sense of subjective uneasiness, a behavioural or physiological response leading to increased heart rate, muscle tension, restlessness, fidgeting, worrying etc. Every individual experiences some form of anxiety almost every day of our lives. This could be because of an exam, a new job, marriage, separation/divorce and many such situations. Experts say that some amount of anxiety is even beneficial for us to be more productive. But it becomes serious when this anxiety goes so out of proportion that actual daily functioning becomes difficult, it is persistent and about situations that may not be generally anxiety-provoking like visiting a restaurant, going to a party, travelling etc.
“The first time it happened, I was driving down a highway and felt a lump in my chest. Like I was almost choking on something. I thought I was going to die. I was sweating but my hands and feet were cold, my heart was racing and I couldn’t breathe properly. I nearly passed out. I don’t know how long this continued but I was so scared”
This overwhelming feeling came to be known as a panic attack, named after the Greek God Pan who terrorized travellers with terrifying screams. A panic attack can be defined as an abrupt experience of intense fear or extreme discomfort that is accompanied by several physical symptoms such as heart palpitation, chest pain, breathing difficulty and even dizziness.
“Panic is one of the more intense symptoms a person with anxiety can have”
- Randall, This is Us (NBC)
Panic attacks can be of two types, expected i.e a person knows specific situations/places that may provoke a panic attack like heights, crowded places but nowhere else do they experience a panic attack. Or they could be unexpected i.e they are uncued and the person may not know when they might experience a panic attack. Panic attacks are a characteristic feature of many anxiety and related disorders.
Most of us tend to use the word anxiety very casually but anxiety is far more serious than temporary fear or nervousness. Nervousness is a temporary, natural response to a stressful situation and tends to pass with time as the situation passes. Fear is an immediate alarm reaction to danger. Fear can lead to a physiological and psychological reaction in response to a threat. It is an immediate response of the autonomic nervous system. Anxiety on the other hand is future-oriented and is characterised by apprehension. It is often a reaction to an unknown or imprecise stimulus. Some symptoms of anxiety can include excessive worrying, fatigue, difficulty in concentration, irritability, muscle tension, difficulty falling asleep or maintaining sleep, muscle tension, increased heart rate, difficulty in breathing etc.
There might be several factors that could cause anxiety and related disorders. They could be biological, psychological, social or interaction of all these factors. There is increasing evidence about the genetic tendency of anxiety disorders. It tends to run in the family in some cases but this only makes a person more vulnerable to experiencing anxiety, it is the other external factors that trigger the genes to activate. Anxiety disorders are also associated with specific brain functioning. The depletion of GABA is associated with increased anxiety. The limbic system is most associated with anxiety disorders. This is because the limbic system is responsible for monitoring the changes in body functioning and also potential danger. This potential danger can evoke a fight or flight response leading to various physical responses as seen in anxiety disorders. Environmental factors like stressful events that one might have experienced including abuse, violence, death of a loved one or any sudden changes in living like unemployment, separation can also be responsible for anxiety disorder. Some people may experience anxiety as a result of underlying medical conditions like cardiac issues, lung anomalies or even withdrawal from certain drugs or alcohol. Research has not been able to narrow down one specific cause but a complex of many things could be responsible for why one may suffer from an anxiety disorder at varying degrees of severity.
There are primarily 4 types of anxiety disorders:
1. Generalized Anxiety Disorder (GAD): People with GAD tend to have excessive anxiety or worry about several things such as personal health, work, social interaction and everyday activities for most days for at least 6 months. This anxiety can be extremely distressing wherein, it may cause impairment in work/ school and social interactions. It can involve excessive worrying about traffic and getting late to work to even routine activities like buying groceries, “ What if I buy this and find a cheaper one later? What if my family doesn’t like this? What if I get a stomach bug after eating this?” Symptoms of GAD include:
Feelings of restlessness or on-edge
Difficulty controlling the worry
Being easily fatigued
Difficulty in concentration or mind going blank
If three or more of these symptoms are present for 6 months or less, then the individual is advised to visit a mental health professional. The professional will rule out the possibility of the presence of any other disorders, physical illness or effects of substance use before giving a diagnosis.
2. Panic Disorder and Agoraphobia: People with panic disorder experience unexpected panic attacks. Yet, it is not necessary that every individual experiencing a panic attack may have panic disorder. Hence if a person has experienced a panic attack and also worries about the possibility of having another one can have a panic disorder. They may completely avoid situations that may lead to a possible panic attack such as avoid unfamiliar places, avoid exercising as it may resemble a panic attack etc.
Agoraphobia, which translates to a fear of crowded places, is an intense fear of two or more of the following:
Using public transportation
Being in open spaces
Being in enclosed spaces
Standing in line or being in a crowd
Being outside of the home alone
People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.
3. Specific Phobia: A phobia is an intense, irrational fear of specific objects or situations. This fear is usually out of proportion to the threat that the object or situation may cause. People with phobias may tend to avoid the feared object or situation, experience intense anxiety if they do encounter such a situation or object. There are several types of phobias that are broadly classified under specific phobias (intense fear of specific objects or situations such as heights, a specific animal, blood etc).
4. Social Anxiety Disorder: People with social anxiety disorder have an intense fear of or anxiety towards social or performance situations. This could include public speaking, public performances, eating around others etc. They worry that their actions will be embarrassing or negatively perceived by other people. This worry makes them avoid social settings.
Treatment of Anxiety and related disorders depends on the severity of the disorder. It could be pharmacological or psychotherapy. Any treatment must be prescribed by a qualified professional after a detailed examination. Most commonly prescribed medications include anti-anxiety drugs like benzodiazepines, beta-blockers and antidepressants. Usually, medications are accompanied by psychotherapy. Along with this, there are several support groups of people experiencing anxiety disorders who help each other by sharing their problems. Some other techniques might be self-help methods like meditating, sleeping well, eating well, working out etc.
Anxiety disorders are one of the most common mental disorders and can affect functioning everyday lives very difficult. In times when mental health disorders are increasing day by day, empathy and compassion are of the essence. We as a society need to educate ourselves about disorders like anxiety so that we can help others who may be suffering from it. Reaching out to others and being a patient and unconditional listener may help them with their symptoms. Dismissing their symptoms, taking their symptoms lightly or even worse blaming them can worsen their illness. If we know someone with anxiety disorder, understanding what may trigger their anxiety can help deal with the anxiety-provoking situation effectively. Most importantly they should be encouraged to seek help from a mental health professional. Even though the symptoms of anxiety can be extremely overwhelming, they are treatable. Just a lot of compassion, empathy, patience, encouragement and non-judgemental listening may take you a long way to help someone with an anxiety disorder.
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Coltrera, F. (2018, May 29). Anxiety: What it is, what to do. Harvard Health Blog. https://www.health.harvard.edu/blog/anxiety-what-it-is-what-to-do-2018060113955.
Garner, M., Möhler, H., Stein, D. J., Mueggler, T., & Baldwin, D. S. (2009, March 26).
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U.S. Department of Health and Human Services. Anxiety Disorders. National Institute of Mental Health.
This article on 'Anxiety Disorder' has been contributed by Smruti Pusalkar, who is a Psychology student from Fergusson College. She is part of the Global Internship Research Program (GIRP), which is under the leadership and guidance of Anil Thomas. GIRP is an Umang Foundation Trust initiative to encourage young adults across our globe to showcase their research skills in psychology and to present it in creative content expression.
Smruti wishes to develop herself to be a more patient listener and a sharp observer to understand the happenings of the world and grow increasingly empathetic. She is passionate about mental health and well being and plans to pursue a career in this field. She is extremely curious about psychology and wants to spread awareness about mental health problems to help those in need.
Anil is an internationally certified NLP Master Practitioner and Gestalt Therapist. He has conducted NLP Training in Mumbai, and across 6 other countries. The NLP practitioner course is conducted twice every year. To get your NLP certification.