Anxiety Disorders

Anxiety is a normal experience.

Moderate or high levels of anxiety can increase alertness and performance in particular situations.

But, some people experience continuous or recurring anxieties, fears, or episodes of intense panic. So much so, that they feel powerless to manage the symptoms and their lives can become severely affected.

There are generally five major anxiety disorders that are referred to:

  1. Panic Disorder,
    Panic Disorder is the fear of having a spontaneous panic attack. The intensity of the attack can be extremely severe and many people feel they are having a heart attack and/or are going to die or are going insane. It is not unusual for people to become fearful and chronically anxious about having another one.
  2. Social Anxiety (sometimes referred to as Social Phobia),
    Social Anxiety is the experience of fear, anxiety and/or panic in social situations where people think they may embarrass themselves or may make a fool of themselves in some way.
  3. Generalized Anxiety Disorder (GAD),
    Generalised Anxiety Disorder is persistence and excessive anxiety or worry which is experienced for six months or more about events or activities which may or may not happen.
  4. Post Traumatic Stress Disorder (PTSD)
    Post Traumatic Stress Disorder (aka Acute Stress Disorder) is the experience, or witness of, or confrontation with an event or events that involved actual or threatened death, or serious injury, or threat of physical injury of self or others. While people with PTSD can experience panic attacks, the major feature of PTSD is the reliving of the event/s through dreams and/or or nightmares or flashbacks.
  5. Obsessive Compulsive Disorder (OCD).
    Obsessive Compulsive Disorder is the experience of obsessive, unwanted thoughts and/or compulsive behaviours that may include rituals which can markedly interfere with day to day living. This can include repetitive behaviours such as cleaning, checking, counting, repeating words silently, or hand washing, e.g. a person who has a fear of contamination (from germs) may wash their hands repeatedly.

Other types of disorders are Specific Phobias or Separation Anxiety.

What makes anxiety disorders worse, is that they become insidious self-fulfilling and self-feeding monsters, instilling fear into the person that they will have an ‘attack’ in public, at work, while shopping … so much so that it can severely restrict their lives. Untreated or unrecognized these affects from anxiety disorders can lead to secondary conditions such as agoraphobia, depression, alcohol and drug abuse, amongst others.

There are three types of clinically recognised anxiety or panic attacks:

  1. Spontaneous (Uncued) Panic Attacks
    Are not associated with a situational trigger and appears to come ‘out of the blue’. They can occur during periods of relaxation or when sleeping.
  2. Situational (Cued) Panic Attacks
    Occur either in anticipation of a situation or in a situation where an attack has previously been experienced.
  3. Situationally Pre-disposed Panic Attacks
    While being pre-disposed to having a panic attack in a certain situation, the person may or may not have an attack either in the situation or immediately afterward.

The American Psychiatric Association (APA) describes a panic attack as ‘a discrete period of intense fear or discomfort that is accompanied by at least four physical or cognitive symptoms’. Specifically, these symptoms include:

  1. palpitations,
  2. sweating,
  3. trembling or shaking,
  4. shortness of breath or smothering,
  5. feelings of choking,
  6. chest pain or discomfort,
  7. nausea or abdominal distress,
  8. dizziness or lightheadedness,
  9. pins and needles,
  10. diarrhoea,
  11. dry mouth,
  12. headache,
  13. derealisation or depersonalisation,
  14. and chills or hot flushes

People commonly also report a fear of losing control in some way or that they are going crazy or will die.

Additionally, adding to the confusion, many people with Panic Disorder can experience various sensations moving through their body – either before or during the actual panic attack. These sensations can change from one ‘attack’ to the next which only adds to the confusion people feel. These sensations include:

  1. Electric current moving through the body
  2. Hot prickly sensation moving through the body
  3. Intense heat or burning pain moving through the body
  4. “Unusual” intense flows of energy throughout the body
  5. Rushes of ‘energy’ shaking the body
  6. Tingly sensation moving through the body
  7. Creeping sensation moving through the body
  8. Wave-like motion of energy moving through the body
  9. Vibration moving through the body
  10. White hot flame through the body
  11. Ice cold sensation through the body
  12. “Ants crawling” sensation over the body

The physical and cognitive symptoms are usually followed by a desire to escape (Fight-or-Flight Response).

Fight or Flight is the body’s natural survival mechanism to prepare us to either stand and face the source of a threat, or to run away. When the response is triggered, adrenalin rushes through the body and any systems not necessary to either escape or fight are shut down.

This all makes perfect sense if confronted with an external threat to our safety. However, when this response is triggered while watching TV, taking a bath or gettin ready to doze off, the effect is overwhelming, and the symptoms of the response along with any of the aforementioned symptoms lead to additional distress and extend the attack over a longer period.

In fact, even after the initial attack has subsided, a person can still feel very anxious and fearful of another attack that in can, in turn, activate another Fight or Flight response … extending the attacks for hours.

You may find that you may dissociate first – and then panic as a result. Dissaciation is generally defined through two main symptoms:

  • Derealisation (a feeling that you and/or your surroundings are not real)
  • Depersonalisation (a feeling that you are detached from your body)

Some people may also find that they have the additional symptoms of:

  • Sensitivity to light and sound
  • Tunnel vision
  • Feeling as though you are looking through a mist
  • Feeling as if your body has expanded so that it feels larger than normal
  • Feeling as if your body has shrunk to minute proportions
  • Stationary objects may appear to move
  • Driving a car and suddenly realise you don’t remember what has happened during all or part of the trip
  • Listening to someone talk and realise you did not hear part or all of what was said
  • Sometimes sit staring off into space, and not being aware of the passage of time

Other symptoms that sufferers of Panic disorder may experience are:

Heart

  • Racing / Pounding
  • Missed heart beats

Breathing symptoms

  • Breathing difficulties
  • Hyperventilation
  • Tightening of the throat
  • Choking sensation

Muscle Tension

  • Chest pain
  • Headaches
  • Neck pain
  • Lower back pain
  • Aching jaw
  • Muscle pain
  • Sciatica

Digestive problems

  • Nausea and/or vomiting
  • Churning/burning stomach
  • Indigestion

Effects

  • Lack of concentration
  • Extreme exhaustion
  • Loss of feelings and/or libido
  • Short term memory loss

Major Fears

  • Fear of dying
  • Fear of having a heart attack
  • Fear of going insane
  • Fear of losing control
  • Fear of embarrassment
  • Fear of making a fool of self
Other Symptoms

  • Pins and needles
  • Hot and/or cold flashes
  • Shaking
  • Trembling
  • Excessive perspiration
  • Sweating hands
  • Giddiness / Light-headedness
  • Frequent need to urinate
  • Diarrhoea
  • Sleeping difficulties
  • Night sweats
  • Unexplained rashes
  • Weakness in left arm

There seems to be three main theories about what causes anxiety disorders. Specifically:

  1. Biological
    This theory presupposes a chemical imbalance (e.g. SDS) in the brain and also includes a genetic contribution for panic disorder. It is assumed that if one member of the family has panic disorder, there is a very good chance that other members of the family would have had panic disorder.
  2. It’s important to note at this stage that until recently, people were not diagnosed with panic disorder – quite often in fact they went without appropriate treatment, or were misdiagnosed completly. It is not uncommon to discover that older family members who are suffering from ‘a nervous breakdown’, alcoholism, or what could be perceived as ‘eccentricity’ is as a result of various avoidance behaviours due to undiagnosed panic disorder.

  3. Behavioural
    This nurture based theory assumes the cause is a learned behaviour, including ‘learned’ negative thought patterns. There is no doubt we ‘learn’ to become afraid of panic attacks, and we can learn very very quickly! From this fear, the multitude of fears grow. Each feeding on each other and impacting severely on daily life.
  4. Psychodynamic
    While not everyone with an anxiety disorder has a history of childhood trauma, many people do. Thus this theory looks at childhood issues as being the cause.
    Childhood issues do not necessarily mean childhood abuse either. For example, as children many people learned that they needed to become, ‘a good nice person’. In doing so, they needed to stop their ‘natural  development’ and became who they thought they should be. The end result of this is low self esteem, fear of being abandoned/rejected, that people won’t love or like us, and feelings of intense loneliness and helplessness.
    Being who we think we should be, creates enormous personal stress as we try to be perfect in every area of our life, including our inability to say ‘no’ even when we want and need to. Over time ‘something’ has to give and the development of an anxiety disorder and/or depression begins.


References and further reading:

Anxiety Disorders Brochure (PDF)
American Psychiatric Association (APA) (USA)

Let’s Talk Facts Brochures & Fact Sheets
American Psychiatric Association (APA) (USA)

Panic Anxiety Disorder Association Inc. (PADA)

Chronic Anxiety
Ronald M. Rapee, David H. Barlow
ISBN-10: 0898627710

Anxiety Recovery Centre Victoria

Anxiety & Stress Management Service of Australia

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