Anxiety
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What is Anxiety?

Anxiety is an internal experience accompanied by physical manifestations. As such, it is hard to put into words. Sometimes, it is described as a feeling of fear and dread. Other times people use the words unease, worry, or apprehensive expectation. It can be viewed as the response to a sense of threat.

If the focus is very specifically related to some real danger in the world, it is considered to be fear. If the perceived threat is less specific, more uncertain, and future-oriented, it is thought of as anxiety.

Anxiety is a common human experience and when manifested more strongly becomes the most common psychological symptom. It is an uncomfortable one, and it is only natural to seek relief.

In this post, we will describe ways of going about doing this, both with medicines and with non-medicine ‘talking therapies.’

Anxiety is Accompanied by Other Distressing Processes

Anxiety does not travel alone. When felt strongly, it is accompanied by other distressing processes, both mental and physical. Among its mental companions are poor concentration, irritability, over-arousal, and a feeling of impending doom.

Physical qualities include rapidly beating heart, sweating, frequent urination, dry mouth, and muscle tremors. Sometimes a distinction is made between ‘trait anxiety’ and ‘state anxiety.’ Trait anxiety is a long-term process in a person somehow more prone to this experience. ‘State anxiety’ is how a person may feel at a given moment.

Fear and anxiety can be helpful in moderation. These symptoms attune us to being vigilant and aware of possible hazards. Further, the ‘fight or flight’ physiology which anxiety generates can help us respond to a truly dangerous situation. In the absence of danger, but in the face of a challenge, in moderation, it can also help spur problem-solving and productivity.

Often though, anxiety and its accompanying features become so strong that they become detrimental, impairing functioning, and can make life very difficult. Anxiety disorders, the name for this situation, are experienced by about 10 percent of Americans at any given time.

Characteristics of people with anxiety

People of all ages are affected by anxiety disorders. Overall, the average age of onset of anxiety disorders as a whole is about 21. Phobias, separation anxiety, and social anxiety tend to start younger, with an average age of 15, while GAD and panic disorder tend to start between 21 and 34 years of age.

These numbers represent averages, though; many children and adolescents—as many as one in three—may have difficulty at some point. The gender distribution depends on the specific disorder: about twice as many women than men suffer from generalized anxiety disorder (GAD) or panic disorder, while social anxiety is experienced about equally by both genders.

Anxiety disorders tend to run in families. About 15-20 percent of close relatives may also experience anxiety symptoms. So far, however, no individual genes have been found to be responsible. Family studies have found clustering of anxiety disorders and depression.  This suggests that their genetics have some commonalities. Some studies have estimated that genetic factors account for 30-50 percent of the likelihood of developing an anxiety disorder, while non-genetic factors may be responsible for 50-70 percent. The absence (so far) of specific genes suggests that anxiety disorders may appear due to a combination of factors including genetic vulnerability, traumatic events, and longer-term qualities of the emotional or physical environment, such as stressful conditions.

Consequences of Anxiety Disorders

Although we remain unsure about the ultimate causes of anxiety disorders, we are beginning to recognize that they are quite common, affecting 40 million Americans. We are also finding that they have significant consequences beyond feelings of discomfort. Some of these consequences are as follows:

  • Persons with a generalized anxiety disorder (GAD) have lower scores on measures of quality of life, social life, and life satisfaction.
  • They are also more likely to be on disability at some point in their lives.
  • When employed, tend to have lower salaries.
  • Their annual medical costs are higher.
  • In the elderly, anxiety often precedes cognitive decline.

GAD is often seen co-existing with other illnesses, including depressive disorders (in almost 50 percent), which have their own consequences on health and well-being. Persons with both anxiety and depression are at 50-80 percent higher risk for cardiac disease, stroke, high blood pressure, and arthritis—comparable to the risks from obesity and smoking.

Unfortunately, anxiety disorders are not always recognized. Only about half of persons with anxiety disorders in primary care practices are receiving treatment. Since there are many effective treatments available, it’s well worthwhile to learn about both their benefits and limitations.

Treatments for Anxiety Disorders

There is a wide range of treatments for anxiety disorders.  As no single treatment is clearly the best for everyone, choosing often involves personal preferences. 

Medicines are usually reserved for moderate-to-severe anxiety.  They come in a large variety of types.  Some such as the benzodiazepines (‘Valium-like’ drugs) have a relatively rapid onset of action, while others such as the SSRIs (selective serotonin reuptake inhibitors) are more for long-term use. The benzodiazepines also raise concerns about the potential for dependence and changes in thinking and memory, and for these and other reasons tend to be used less widely. 

Some medicines such as hydroxyzine can be helpful but may be limited because of drowsiness.  Others, such as mirtazapine are approved by the Food and Drug Administration for other purposes (in this case depression) but sometimes are prescribed ‘off-label’ for anxiety.

In working with a doctor to choose a medicine, it’s important to learn about its possible benefits and side effects and to find a balance that feels right.

Non-Medication Therapies

Non-medicine (‘talking’) therapies are widely used, particularly for mild-to-moderate levels of anxiety. There are different types. Some view anxiety as a learned response that needs to be unlearned. 

More ‘psychodynamic’ therapies look into how one’s past experiences influence the present situation.  Interpersonal therapy emphasizes relationships with others. 

Cognitive therapies consider possibly unhelpful or incorrect assumptions that a person may be making as well as inaccurate ways of thinking. 

These approaches are not at all incompatible with taking medicines.  Indeed, they often work well hand in hand at the same time, and complement each other’s benefits.

Additional Articles by this Author:
How to Recognize the Many Different Forms of Anxiety
Anxiety: How to Decide Which Treatment is Best for You

Conclusion

It’s important to keep in mind an appropriate goal. Anxiety is uncomfortable so it is natural to try and reduce it. On the other hand, it may not be realistic to envision living totally anxiety-free. 

Anxiety in moderation is a normal response to challenges and can be helpful, for instance in motivation and learning. The goal is to limit it to this degree so that it is a part of normal living while preventing excessive amounts which makes things harder instead of easier. 

As we have described here, there are a number of tools to help do this. Learning about what anxiety is, and understanding the treatments that are available, is an important first step.

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