Getting Clarity on Your Anxiety

If you’re reading this there’s a very good chance you’re sick of feeling anxious, you’d like to get it to change and the things you’ve tried so far haven’t worked (more than a for short time at least).  In order to make large, long term changes on anxiety understanding it more fully is a necessary place to start.

People are often unsuccessful in managing their chronic anxiety well and it’s almost never for a lack of effort.  Instead, it tends to be for a lack of understanding of how their particular pattern of anxiety works. When you start to get clarity on your anxiety you’ll begin to understand its parts and how the pattern of it works.  

We can’t change something we have little awareness of.

Clarity Through Diagnosis

In order to build awareness of the anxiety you are struggling with it often can be a very useful place to start with reading through the different types of anxiety.  

Having a sense of the type, or types, of anxiety you have puts you in a much better place of being able to do see through a sea of confusion and stress to pick up on the main patterns of the anxiety.

If you can name it, you can begin to tame it.

There are many forms of anxiety that have been narrowed down into distinct diagnoses.  I have outlined all the major anxiety diagnoses below. But first, a word of caution before you start:

Social Anxiety Disorder

Social anxiety disorder (also known as social phobia) is an intense anxiety or fear of being judged, negatively evaluated, rejected, or humiliated in a social situation. The feared judgements are often related to being seen by others as incompetent, awkward, weird, stupid or weak.  People that struggle with this form of anxiety often are overly focused on themselves and fear acting oddly or appearing visibly anxious (such as blushing, sweating or fumbling with words).

This type of anxiety goes well beyond shyness.  Many people with this type of anxiety have strong physical symptoms in social situations, such as

• rapid heart rate
• sweating
• nausea  
• blushing
• trembling
• “mind going blank”

Though people with social anxiety understand that this anxiety is excessive, rationality doesn’t help to make it any better.  As a result, social anxiety often drives people to avoid social or performance situations. The typical types of social situations that are feared and avoided are:

• public speaking
• talking to strangers
• initiating conversation
• ending a conversation
• dating
• blushing in public
• writing when others are present (for example signing a credit card authorization)
• being watched at work
• crowds
• making eye contact
• entering rooms
• using public restrooms
• going to parties
• eating in front of other people

While over 90% of people with social anxiety avoid at least one of the types of situations above, there are the 10% of people that have intense social anxiety that don't avoid social situations. In reality, more often than people would think elite performers like actors struggle with social anxiety.

Social phobia is very common and is equally experienced between men and women.  While it can begin at any age, it most often shows up starting around age 13. Roughly 5 - 13%  of people will struggle with social anxiety at some point during their lives. About 7% of the U.S. population has social anxiety disorder at any one time, making it the most common anxiety disorder.  Sadly, more than ⅓ of people with social anxiety disorder report experiencing symptoms for 10 or more years before seeking help.

Generalized Anxiety Disorder (GAD)

Worry is a common feature of life these days for most of us in the modern world.  There’s so much we are attending to each day that it’s hard to imagine how any of us can not struggle with a mind that wanders into the past or future more than we would like.

Past this common experience of worry that most people experience, there is a group of people that struggle with being extremely worried about a whole range of concerns more days than not.  The worry often appears even when the person knows logically that the level of worry is not appropriate for the situation and that it’s only making things worse.

Yet, unfortunately that knowledge doesn’t seem to help them from worrying excessively about a range of concerns like money, relationships, and work.  The everyday hassles that we all encounter can make the sufferer of GAD highly stressed and often overwhelmed. Further, it is often the case that this level of stress and anxiety impairs their ability to function well at work, at home or both.

GAD tends to develop slowly over time and can often begin at a younger age.  It is common for people to report feeling like they are “just an anxious person” or that their family has noted that they “have always been a worrier”.  

Symptom Checklist:

• overthinking a situation or dwelling on what will go wrong (as an attempt to reduce anxiety)
• inability to stop worrying even if it doesn't seem to solve anything
• feeling tense, nervous, restless, or on edge
• muscles that ache and are sore from excessive tension
• tiring easily
• difficulty concentrating or having a mind that goes blank
• overly irritable with others
• trouble sleeping

People that struggle with the symptoms above often have a persistent sense that they have little control over the stressful parts of their lives and so they are left with what they can control - worrying about the future.  

This addiction to worry works like other addictions, it's short term relief with long term consequences even if the person “knows better”. The more one worries the more one gets caught in the loop of feeling as though they need to worry.  

GAD is the most common of the anxiety diagnoses and women are twice as likely to be affected as men. 

Panic Attacks

A panic attack is a sudden rush of fear that happens with intense physical sensations, a strong urge to escape or get away from the situation and a sense that something really bad is about to happen.  Often when someone is experiencing a panic attack they feel as they they are totally losing control, having a heart attack or even dying.

A panic attack is characterized by four or more of the following symptoms:

• palpitations, pounding heart, or accelerated heart rate
• sweating
• trembling or shaking
• sensations of shortness of breath or smothering
• a feeling of choking
• chest pain or discomfort
• nausea or abdominal distress
• feeling dizzy, unsteady, lightheaded, or faint
• feelings of unreality or being detached from oneself
• fear of losing control or going crazy
• fear of dying
• numbness or tingling sensations
• chills or hot flushes

It can be common that these attacks can come from seemingly nowhere or unexpectedly without any obvious trigger, even during sleep.  This aspect can significantly increase the scariness of panic attacks because it can be hard to make sense of them or predict them in the future.  While stressful times can certainly increase the chance of having one, they can still show up during periods of calm or even in sleep.

Panic attacks are more common than you might realize.  Research indicates they somewhere between 10 - 33% of people experience at least one per year.

Panic Disorder

Having panic attacks does not necessarily mean someone has panic disorder.  Someone could have one panic attack in their life and develop crippling panic disorder while someone else could have many panic attacks without developing panic disorder.  Let me explain the difference.

Panic disorder is when someone experiences at least one panic attack and has excessive anxiety and worry about having another panic attack.  The anxious thoughts about what would happen may look like some of the following common fears:

• you'll die
• you’ll lose control, faint, "go crazy", vomit, or have diarrhea
• you'll humiliate yourself, lose your job, or have to be hospitalized for psychiatric issues

The key factor for panic disorder is that these fears change the person's behavior to prioritize safety and this limits their life in significant ways.  Here are a list of common behaviors people with panic disorder do to attempt to make themselves feel safe from panic.

• carrying safety items at all times (medication, money, cell phone, water)
• always bringing someone along when leaving the house
• needing to know where your spouse, partner, or other "safe" person is at all times
• sitting close to exits when at the movies or in a restaurant
• avoiding activities that increase your heart rate like exercise, sex and scary movies
• frequently checking your pulse or blood pressure
• using alcohol and drugs to calm you down
• excessively avoiding substances like caffeine, alcohol, or foods that make you feel too energized
• heavy reliance on distraction in order to keep calm (social media, games, watching TV)

If you experience panic attacks but don’t relate to these behaviors listed above then you likely do not have panic disorder.  However much can still be done to help you address the panic attacks.

Agoraphobia

Agoraphobia is a type of anxiety that is focused on fear of places or situations that might cause you to panic and that you wouldn’t be able to escape easily from.  The fear can often be related to being scared of feel trapped, helpless or that you’ll be humiliated for losing control in front of others or in public.

The majority of people with agoraphobia develop it after having one or more panic attacks.  The intensity of a panic attack can cause them to worry about having another attack and then they begin to avoid the places where it may happen again.

Some of the most common situations people that with agoraphobia avoid are:

• being alone
• being away from home
• driving (especially on highways, bridges & in traffic)
• crowded public places (grocery store, movie theater, malls, sports events)
• enclosed & confined places (elevators, small rooms, tunnels, bridges, airplanes, subways, buses, long lines)

Unfortunately these types of safety seeking behaviors become a vicious cycle. The more someone labels these types of situations as unsafe and avoids them, the more the fear about them grows.  This avoidance can significantly interfere with the person’s life and also gets in the way of them building useful coping skills instead.

Similar to GAD, this is a disorder that is twice as common in women than in men.

Obsessive Compulsive Disorder (OCD)

There are many times when being organized, responsible, neat and tidy can help someone to live better.  On the other hand, when these types of behaviors and following of rules take over then OCD can become a large problem.  OCD is a common, chronic disorder that is made of two parts - obsessions and compulsions.

Obsessions

Obsessions are uncontrollable, recurring thoughts, impulses, or images that trigger intense anxiety.  Here's a list of some common examples of obsessions:

• that you might harm self or others
• dirt, germs, or bodily secretions
• contaminants (asbestos, radiation, toxic waste)
• getting ill from possible contaminants
• fear of blurting out obscenities or insults
• being responsible for something terrible happening (hitting someone with your car, a fire, burglary)
• sexual thoughts, images, or urges
• sacrilege and blasphemy, right/wrong, or morality
• someone will have an accident unless things are in the right place
• saying certain things because they might come true
• fear of losing things
• fear of animals and insects

Compulsions

Compulsions are repetitive behaviors or rituals that a person with OCD feels the urge to do following having an obsessive thought, image or impulse in order to have a temporary relief or feeling of safety.  Here are the common types:

Not all rituals or habits are compulsions. Everyone can find themselves double checking things sometimes. The difference between healthy levels of anxiety and OCD is the person with OCD:

• feels like there isn’t an ability to control their thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
• they spend at least 1 hour per day on these thoughts or behaviors
• the compulsions may bring a sense of relief but no real pleasure
• have some significant problems in their daily life due to the severity of this anxiety

Though people with OCD typically understand their obsessional thoughts images and impulses to be excessive and unreasonable, it does not help to make them stop or to be less stressful.  In fact, the obsessions usually are reported as being quite intrusive (happening despite trying to not think of them). The stress can become so intense that some people get worked up into a panic attack from them.

Likewise, people with OCD often understand that their rituals are excessive and unreasonable. Yet they continue to do them and chase the sense of relief.  Unfortunately the relief is only short lived and the anxiety returns quickly.

Not only does this not work, research indicates that these attempts to suppress anxiety tends to increase the frequency and intensity of the anxiety over time.  The vicious cycle of OCD is fed by the very thing that they feel like they must do.

OCD affects approximately 1% of the U.S. population and is equally common among men and women.  The average age of onset is 19, with 25 percent of cases occurring by age 14.

Phobias

There are many things that can be frightening to most people, like driving over very high bridges or using an old creaky elevator.  Most people are able to manage their fears and not let them affect their daily life. However, when someone develops a clinically significant phobia they experience a very strong fear reaction to places, situations or objects, even though they can recognize that logically there is no actual threat.  

When exposed to the feared object or situation, a person with a phobia experiences an immediate reaction of intense anxiety and a strong urge to run from or avoid the object or situation. This amount of stress and the need to avoid can significantly interfere with the person's ability to function.

Someone could struggle with a singular phobia or have multiple.  The most common types of phobia are:

• animal phobias (snakes, rats, spiders, dogs, insects)
• heights
• flying
• closed-in spaces (like an elevator)
• riding in a car or on public transportation
• driving
• going over bridges or in tunnels
• being injured, blood, injections
• storms and lightning
• fear of costumed characters (clowns)
• choking
• vomiting

Most people with phobias never get professional help.  Instead they find a way to just avoid the objects and situations they are scared of.  For many, this is a workable solution. If they are scared of sharks they just avoid the ocean.  However, when the need to avoid starts to get in the way of important aspects of a person’s life it becomes a much bigger problem. 

An example of this would be the common phobia of flying.  If a parent wanted to visit their child in another city and needed to fly to get there then they are left with a decision.  They can either have relief and a sense of control in the short term or they can spend time with their child, but they can't have both in this scenario.

Life that is dictated by fear can have some high costs of missing out on key aspects of life and relationships.

Approximately 10% of the general population will have a specific phobia during their lifetime and women are about twice as likely to be affected by phobias than men.  While symptoms can appear at any age, it is common for them to start in childhood (~age 7). When they show up for the first time in adulthood they are more likely to start suddenly and last longer than when appearing in childhood.   About 20% of phobias that appear in adulthood tend to resolve on their own, without treatment.

Post-Traumatic Stress Disorder (PTSD)

When a person encounters a situation that is too much or too fast for their coping at that moment to handle, it can overwhelm their nervous system and potentially cause an emotional scar we call trauma.  

When someone finds themself in an overwhelming or dangerous situation it is healthy and normal to experience a significant amount of fear.  This fear helps someone make very fast choices and reactions in order to avoid danger. After the danger has passed most people recover and their nervous system will return to baseline.  However, some people find that their nervous system don’t come back down and the primal flight-or-fight reactions continue to be triggered easily and often.

Patterns Following Trauma

A traumatic event may have happened in the past but trauma is the stress that lives on in the nervous systems of the people who were affected.

The nervous system is made of two basic parts – the gas pedal (sympathetic) and the brake pedal (parasympathetic).  The effects of traumatic stress can be seen both in the body and the mind creating a hard time balancing between the gas and the brake evenly.

Here are the two basic patterns seen in those that have a nervous system with unresolved trauma:

1) Too Much Gas Pedal – Over-Activation of the Nervous System

Anxiety, panic attacks, anger and rage outbursts, racing thoughts, chronically tight muscles

2) Too Much Brake Pedal – Under-Activation of the Nervous System

Depression, apathy, exhaustion, numbness, dissociation, disconnection in relationships

Official Symptoms of PTSD

PTSD is a cluster of symptoms that arise following of a traumatic experience, that persist for at least one month and significantly interfere with a person's ability to work or relate to other people in their lives.  

There are four categories of symptoms that a professional looks for when assessing someone for PTSD.

A Second Type of Trauma

In addition to the type of trauma above (trauma from an isolated, severe event), many trauma experts agree that trauma can occur early in life due to the effects of:

• childhood neglect
• emotional abuse
• physical abuse
• bullying
• severe injury or medical procedures

This type of trauma is known as developmental or complex trauma and often persist into adulthood unless treated.  Our natural reaction to stressful situations is to resist/fight, run away or freeze. When the types of overwhelming situations happen to a child their nervous system can lose the ability to resolve the stress and move forward.  They can get stuck in the fight, flight or freeze responses and become emotionally and physically unbalanced.

The signs of PTSD can slowly appear after a trauma has been experienced and can take weeks or months to fully show up.  It is often accompanied by depression, substance abuse, or another anxiety disorder.

Women are more likely to develop PTSD than men.  Rape and childhood sexual abuse are strong predictors of experiencing PTSD.

You’re Not Alone

Many people with significant anxiety feel alone, cut off and isolated.  It may feel like your anxiety is so overwhelming and such a problem for you that no one can really understand it.  

The reality is that you’re not alone, and far from it.  Literally hundreds of millions of people, in every country of the world struggle with anxiety.  Anxiety disorders are some of the most common mental health struggles, affecting around 30% of people at some point in their life.  

Better still, not only is anxiety common, anxiety disorders are well researched and understood.

Real Life is Messy

These official diagnoses are just a best attempt at taking a complicated topic and drawing lines as neat as possible to make some clear cut categories.  Having categories is a helpful thing in a number of ways but real life often isn't as neat as it looks on paper.

You might find yourself matching very closely with a diagnosis. If so, excellent, this can be headstart to making some freeing changes in your life.  

However, it’s often very common to feel like your struggles are a bit of this and a bit of that and don’t neatly fall into one category.  This isn't a problem.  Under the surface, these diagnoses have a lot in common and you can still gain a lot of insight about your struggles when you start to understand how anxiety becomes a vicious cycle in your life.  

A Common Thread

While OCD might look different than social anxiety disorder and agoraphobia might look different than PTSD, in fact they all share some common elements.  

All these variations of anxiety noted above share a common thread --

Each diagnosis is a unique way of resisting, fighting, or avoiding anxiety.

Another way of saying this is that all anxiety disorders are a different flavor of making anxiety the enemy.

These diagnoses become severe when defeating anxiety or avoiding uncertainty at all costs becomes more important than living well.  Once in motion, escaping the vicious cycle of control becomes increasingly harder and harder to let go of.

Good News

If you notice yourself in some of the patterns above then this may be an opportunity for growth and understanding yourself better.

If you notice your strategies only work in the short-term (distraction, isolating, opting out, over-thinking, pretending it's all okay) then you are ripe for learning new skills and to try a different set of strategies that are much more likely to help.

We are fortunate to live in a time when anxiety disorders are well understood and the science of clinical psychology has treatments that are research backed to be effective for most people.