Anxiety is a normal and often healthy emotion. However, when a person regularly feels disproportionate levels of anxiety, it might become a mental-health disorder.
Anxiety disorders form a category of mental health diagnoses that stem from excessive nervousness, fear, apprehension, and worry. These disorders alter how a person processes emotion and behaves, which can manifest into a broad range of physical symptoms.
Anxiety conditions at a clinical level are often categorised into specific categories in order to be able to determine the anxiety’s onset trigger(s) which will give guidance as to the best therapeutic treatment in response. In most cases, anxiety will fall into the ‘Generalised Anxiety Disorder’ (GAD) category notwithstanding there being varying degrees of intensity. For example, ‘mild anxiety’ might be vague and unsettling, while ‘severe anxiety’ may seriously affect ones’ day-to-day living. Severe anxiety can be expressed as ‘an emotion characterised by feelings of tension, worried thoughts and physical changes like increased blood pressure’.
Symptoms of severe Anxiety include
- Restlessness and a feeling of being “on-edge”;
- Constant feelings of being afraid;
- Uncontrollable feelings of worry & impending disaster;
- Increased irritability;
- Concentration difficulties;
- Sleep difficulties such as problems in falling or staying asleep.
Indeed, the causes of anxiety disorders are complicated. Many might occur at once, some may lead to others, and some might not lead to an anxiety disorder unless another is present. Severe symptoms of anxiety can sometimes also occur when people experience challenging or traumatic life events, including grief and bereavement.
Possible causes of anxiety include:
- Environmental stressors such as difficulties at work, relationship problems or family issues;
- Genetics as people who have family members with an anxiety disorder are more likely to experience one themselves;
- Medical factors such as the symptoms of a different disease, the effects of a medication or the stress of an intensive surgery or prolonged recovery;
- Brain chemistry as psychologists define many anxiety disorders as misalignments of hormones and electrical signals in the brain;
- Withdrawal from an illicit substance the effects of which might intensify the impact of other possible causes;
Often, severe symptoms of anxiety can sometimes occur when people experience challenging or traumatic life events including grief and bereavement.
‘Anticipatory anxiety’ is also a particularly prevalent and specific type of anxiety. Anticipatory anxiety is where a person experiences increased levels of anxiety by intractably thinking about an event or situation in the future. Anticipatory Anxiety can be extremely draining for people as it can last for months prior to an event. The worries people experience specifically focus on what they think might happen, often with catastrophic predictions about an event. The nature of negative predictions about the event will be the difference between an anxiety level that is incapacitating or merely uncomfortable.
‘Social anxiety’ (SAD) is also a particularly prevalent and specific type of anxiety. It is a type of anxiety which is driven by one’s fear of being embarrassed, humiliated, rejected or looked down on in social interactions. In social anxiety disorder, the fear triggered anxiety will usually lead to active avoidance of social occasions thus disrupting one’s daily and life’s routines, including work, school and social interactions which can lead to social isolation. To learn more about social anxiety disorder please click on the following link –social anxiety disorder >>
‘Phobia related anxiety’ is also is also a particularly prevalent and specific type of anxiety. A phobia related disorder is generally triggered by an extreme or irrational fear of or aversion to something, including:
- Acrophobia – (i.e., fear of heights);
- Aerophobia – (i.e., fear of flying);
- Agoraphobia – (i.e., fear of entering open or crowded places, of leaving one’s own home, or of being in places from which escape is difficult);
- Arachnophobia – (i.e., fear of spiders);
- Astraphobia – (i.e., fear of thunder and lightning);
- Autophobia – (i.e., fear of being alone);
- Claustrophobia – (i.e., fear of confined or crowded spaces);
- Germaphobia – (i.e., fear of contamination and germs – see also bacteriophobia);
- Hemophobia – (i.e., fear of blood);
- Hydrophobia – (i.e., fear of water);
- Ophidiophobia – (i.e., fear of snakes);
- Thanatophobia – (i.e., fear of death);
- Zoophobia – (i.e., fear of animals).
‘Fear of failure’ is also a particularly prevalent and specific type of anxiety. Fear of failure (also called “atychiphobia”) is when we allow that fear to stop us doing the things that can move us forward to achieve our goals. While we all hate to fail, for some people, failing presents such a significant psychological threat their motivation to avoid failure exceeds their motivation to succeed. This fear of failure causes them to unconsciously sabotage their chances of success, in a variety of ways. Some theorise that this acute ‘fear of failure’ can be linked to having critical or unsupportive parents though there are many recorded and anecdotal causes.
‘High-Functioning Anxiety’ – unlike clinical disorders, high-functioning anxiety does not produce intense physical symptoms of anxiety that influence behaviour. Anxiety is experienced, and it may include some physical dimensions (elevated heart rate, sweaty palms, butterflies in the stomach, etc.), but they usually aren’t strong enough to limit activity or be noticed by outside observers.
High-functioning anxiety is sometimes compared to generalized anxiety disorder because of its omnipresent yet somewhat vague nature. But there are overlaps with other anxiety disorders as well, and in contrast to GAD high-functioning anxiety doesn’t create debilitating physical responses, attach as quickly to specific triggers, or cause significant avoidant behaviours. High-functioning anxiety sufferers generally push through their feelings and do what they have to do, even though they frequently feel discomfort before, during, and after their encounters with people or environments that cause them stress.
The emotional and behavioural symptoms of high-functioning anxiety include:
- Feelings of worry and anxiety that ruin attempts to relax, or that appear even when things seem to be going well;
- Perfectionism and feelings of constant dissatisfaction with performance;
- Workaholism, or a need to keep moving or doing even when at home;
- Overthinking and over-analysing everything, and frequent second-guessing after choices are made;
- Discomfort with emotional expression, unwillingness to discuss true feelings;
- Frequent anticipatory anxiety before a wide range of events or encounters;
- Obsession with fears of failure or of the negative judgments of others;
- Superstitions (the need to repeat certain behaviours or patterns over and over to stave off disaster);
- Periodic insomnia, inconsistent sleeping habits;
- Irritability and quickness to become frustrated or discouraged in the face of setbacks;
- Difficulty saying no, no matter how time-consuming, inconvenient, or complicated the request;
- A false sunny disposition: secret pessimism that conflicts with public expressions of optimism;
- A range of unconscious nervous habits (fingernail biting, hair pulling or twisting, idle scratching, lip chewing, knuckle cracking, etc.);
High-functioning anxiety sufferers often lack self-esteem and self-confidence, and they attempt to compensate for their insecurities by constantly pushing themselves to do better or to please others. Unfortunately, their goals are often unrealistic, and their failure to meet them only reinforces their chronic feelings of tension and inadequacy.
‘Substance-induced Anxiety’: Several drugs can cause or worsen anxiety, whether in intoxication, withdrawal or as side effect. These include alcohol, tobacco, cannabis, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs like heroin), stimulants (such as caffeine, cocaine and amphetamines), hallucinogens, and inhalants. While many often report self-medicating anxiety with these substances, improvements in anxiety from drugs are usually short-lived (with worsening of anxiety in the long term, sometimes with acute anxiety as soon as the drug effects wear off) and tend to be exaggerated. Acute exposure to toxic levels of benzene may cause euphoria, anxiety, and irritability lasting up to 2 weeks after the exposure.
‘Fear of death Anxiety’: Thanatophobia is commonly referred to as the fear of death. More specifically, it can be a fear of death or a fear of the dying process. It’s natural for someone to worry about their own health as they age. It’s also common for someone to worry about their friends and family after they’re gone. Thoughts of death have the ability to create a sense of powerlessness, loneliness, and meaninglessness, and for some individuals, may seriously undermine their experience of happiness or peace. Although people may develop helpful methods of managing their fears of death, such as building relationships and working towards meaningful goals, they may equally engage in maladaptive coping strategies, such as avoidance. As a result, death anxiety has been argued to be a transdiagnostic construct, contributing to the development and maintenance of numerous mental health conditions.
Left untreated, anxiety disorders can become debilitating. In some extreme cases, anxiety can result in short or prolonged periods of a type paralysing panic (Catatonia) and/or mutism (SM ). Furthermore, suffering an extended period of anxiety is thought to be a major cause of depression and related disorders
Fear versus Anxiety: is there a difference?
The main function of fear and anxiety is to act as a signal of danger, threat, or motivational conflict, and to trigger appropriate adaptive responses. For some authors, fear and anxiety are undistinguishable, whereas others believe that they are distinct phenomena. Fear of failure ought not be confused with a fear of one’s safety.
Although both are alerting signals, they appear to prepare the body for different actions. Anxiety is a generalized response to an unknown threat or internal conflict, whereas fear is focused on known external danger.
Ethologists define fear as a motivational state aroused by specific stimuli that give rise to defensive behaviour or escape. Animals may learn to fear situations in which they have previously been exposed to pain or stress, and subsequently show avoidance behaviour when they reencounter that situation. Young animals may show an innate fear reaction to sudden noise or disturbances in the environment, but rapidly become habituated to them. When they are used to a familiar environment, then a fear of novelty may develop. Ethologists have also made the important observation that fear is often mixed up with other aspects of motivation. Thus, conflict between fear and approach behaviour may results in displacement activities (eg, self-grooming in rats). Such displacement activities may be the behavioural expression of an anxious state, but anxiety is a concept that is apparently not used by ethologists, perhaps because their definition of fear does in fact include all the more biological aspects of anxiety.
The fact that anxiety and fear are probably distinct emotional states does not exclude some overlap in underlying brain and behavioural mechanisms. In fact, anxiety may just be a more elaborate form of fear, which provides the individual with an increased capacity to adapt and plan for the future. If this is the case, we can expect that part of the fear-mediating mechanisms elaborated during evolution to protect the individual from an immediate danger have been somehow “recycled” to develop the sophisticated systems required to protect us from more distant or virtual threats.
‘Passive Avoidance’ can drive anxiety related disorders
CBT often engages ‘psychoanalytic’ processes, a form of analysis which delves into one’s past, to help identify ‘passive avoidance’ which has a clear link to anxiety related disorders, including phobias. Indeed, passive avoidant behaviour can sit deep in one’s unconscious so as not to be plainly obvious to the sufferer.
The underlying subject of the avoidance, may lay dormant, simmering beneath the surface, until an emotional response is triggered by a particular stimuli, causing the sufferer to react (objectively) drastically and irrationally. For example, a particular smell or song could trigger a drastic and irrational emotional response to the previous loss of a loved one; similarly, a particular expression on someone’s face, otherwise objectively benign, could trigger a drastic and irrational response if interoperated as a threat (fear response) causing the sufferer to retreat or to lash-out.
There are many possible combinations of stimuli triggers and seemingly irrational behavioural responses, some of which could stem back to a repressed childhood trauma or some other type of repressed anguish. Sometimes this type of behaviour is diagnosed as ‘Neurosis‘, however, neurosis is of a more generalised ‘worrisome tendency’ type of behaviour as opposed to an extreme, drastic and/or irrational reactive behaviour stemming from an unconscious phenomena.
Of course, avoidance is a natural and adaptive response to danger. Animals, including humans, cannot survive without the ability to avoid harm. Nevertheless, avoidance can have detrimental consequences – excessive and/or unnecessary avoidance is a hallmark of anxiety disorders. The idea is that basic emotions such as anger, fear, happiness, sadness, and disgust evolved for particular functions. It is likely, for example, that the basic emotion of fear evolved to enable an organism (including a human) to rapidly detect and respond to danger in its environment. Much research has been conducted on the brain’s fear system in both animals and humans. The fear system involves a range of neural areas, in particular the ‘amygdala’, and this system is especially sensitive to naturally occurring fear-relevant stimuli, such as for example, snakes or angry faces. From this perspective, it should come as no surprise that different emotions may be characterised by quite different patterns of cognitive biases.
By uncovering and examining such reactive cognitions through psychotherapy, it is possible to teach a sufferer different ways to recognise and manage these the underlying avoidance and cognitions so as to at least significantly reduce the intensity of the reactive behaviour with the view to eradicating it altogether.
Getting help for your anxiety
While it is never too late to seek out professional help, the sooner you do the better the possibility of assisting you identify and alleviate the problems affecting you.
Cognitive behaviour therapy (CBT) is a great option if you’re struggling with Depression or Anxiety
CBT is an effective treatment for a range of mental and emotional health issues, including for anxiety and depression. Research has shown CBT to be particularly effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalised anxiety disorder, major depressive disorder (MDD) among many other conditions.
CBT is the most widely-used therapy for Anxiety & Depression related disorders. To learn more about CBT please click on the following link – about CBT >>
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In severe cases of a mental health disorder, including severe cases of any those disorders described herein, or any others such as bipolar disorder, psychosis or schizophrenia, medication may need to be prescribed to the sufferer. Only a Psychiatrist can legally prescribe medications to address such disorders, for example antipsychotic drugs and antidepressants.
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 Researchers are learning that anxiety disorders run in families, and that they have a biological basis, much like allergies or diabetes and other disorders. Anxiety disorders may develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events- per ‘Anxiety & Depression Association of America’
 Selective mutism (SM) is an anxiety disorder in which a person who is normally capable of speech cannot speak in specific situations or to specific people. Selective mutism usually co-exists with social anxiety disorder. People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or punishment.
 Craig KJ., Brown KJ., Baum A. Environmental factors in the etiology of anxiety. In: Bloom FE, Kupfer DJ, eds. Psychopharmacology: the Fourth Generation of Progress. New York, NY: Raven Press; 1995:1325–1339.
 ‘Psychoanalysis‘ is defined as a set of psychological theories and therapeutic techniques that have their origin in the work and theories of Sigmund Freud. The core of psychoanalysis is the belief that all people possess unconscious thoughts, feelings, desires, and memories; and that the unconscious mind, includes all of the things that are outside of our conscious awareness, such as early childhood memories, secret desires, and hidden drives. According to Freud, the unconscious contains things that we might consider to be unpleasant or even socially unacceptable. We bury these things in our unconscious because they might bring us pain or conflict. While these thoughts, memories, and urges are outside of our awareness, they still influence how we think and behave. In some cases, the things that are outside of our awareness can influence one’s behaviour in negative ways and lead to psychological distress.
Author: Tim Pratten
Principal CBT Counselling & Psychotherapy
Title: About Anxiety – Do I have anxiety?