What is Anxiety?
Fear is an automatic reaction of our bodies that gets us ready to either confront or escape from an immediate or upcoming danger. This might be a threat that is real or only imagined. Anxiety is closely associated with fear and describes a state where we’re apprehensive about future events or situations that we see as threatening. This includes a mix of thoughts, feelings, and physical reactions, and actions we take to get ready for what we expect.
Pathological anxiety, on the other hand, occurs when our perception of a threat is blown out of proportion, or when we mistakenly see danger where there isn’t any. This leads to over-the-top and misplaced responses.
It’s worth noting that while many people suffer from anxiety, the exact numbers aren’t known. This is because some don’t seek help, or healthcare professionals fail to correctly identify the disorder.
What Causes Anxiety?
Anxiety disorders seem to result from a combination of biological, psychological, and environmental factors. A person’s genetic makeup, interacting with stressful or traumatic events, can lead to serious mental health conditions.
Anxiety can be triggered by:
* Prescription drugs
* Herbal treatments
* Substance misuse
* Shocking incidents or trauma
* Experiences from childhood
* Panic conditions
Risk Factors and Frequency for Anxiety
Anxiety is a prevalent mental health issue, with specific types affecting people at different rates. The most common type is specific phobia, affecting 12.1% of people over a year. Next is social anxiety disorder, experienced by 7.4% of people annually. Agoraphobia is the least common with a 12-month occurrence rate of 2.5%. Anxiety disorders are more often seen in females than males, with the ratio being approximately 2:1.
- Various types of anxiety disorders exist, but the most frequent is specific phobia, affecting 12.1% of people every year.
- Social anxiety disorder comes second, with a yearly prevalence rate of 7.4%.
- The least occurring anxiety disorder is agoraphobia, with an annual prevalence rate of 2.5%.
- Anxiety disorders are more common in women, with a ratio of nearly twice as many women affected as men.
Signs and Symptoms of Anxiety
Anxiety can manifest in a variety of ways, and it is often more than just growing worries or concerns. It involves a range of symptoms that affect both the mind and body. Here are four main categories of anxiety symptoms:
- Cognitive symptoms: This includes having irrational fears such as fear of losing control, fear of physical harm or death, fear of being evaluated negatively by others, having frightening thoughts, images, or memories, feeling detached from reality, trouble concentrating, being highly alert to potential threats, and difficulty in speaking.
- Physiological symptoms: Involves physical changes like increased heart rate or palpitations, shortness of breath, rapid breathing, chest discomfort, feeling lightheaded, breaking into a sweat, experiencing hot flashes or chills, upset stomach or diarrhea, trembling, tingling in arms and legs, rigidity in muscles, and dry mouth.
- Behavioral symptoms: These include behaviors like avoiding places or situations that trigger anxiety, restlessness, agitation, rapid breathing, or becoming motionless due to fear.
- Affective symptoms: These emotional responses include feelings of nervousness, being frightful, feeling edgy or jittery, or frustration and impatience.
Specific anxiety disorders, defined by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5), also display unique symptoms:
- Separation Anxiety Disorder: Excessive fear or anxiety about being separated from people they are attached to, including symptoms like nightmares and physical symptoms.
- Selective Mutism: Failure to speak in social situations even when there is an expectation to do so, even though the individual can speak and understands the language.
- Specific Phobia: Fear or anxiety about specific objects or situations which are avoided or confronted with fear or anxiety.
- Social Anxiety Disorder: Intense fear or anxiety of social situations in which one could be scrutinized negatively.
- Panic Disorder: Recurrent, unexpected panic attacks along with persistent concern about having another attack and the resulting alterations in behavior.
- Agoraphobia: Fear and anxiety in circumstances like using public transport, being in open or enclosed spaces, being in a crowd, or being outside home alone.
- Generalized Anxiety Disorder: Persistent and excessive worry about various aspects of life, including work and school performance.
- Substance/Medication-Induced Anxiety Disorder: Anxiety caused by substance intoxication, withdrawal, or medical treatment.
- Anxiety Disorder Due to Other Medical Conditions: Anxiety resulting from other medical conditions, for example, endocrine disease, cardiac problems, respiratory illnesses, metabolic disturbances, and neurological disorders.
Testing for Anxiety
If you have symptoms that don’t seem to be caused by any other known medical condition, your initial lab tests might only include a complete blood cell count, a chemistry profile, thyroid function tests, urinalysis, and a urine drug screen.
On the other hand, if your anxiety symptoms are unusual or if there are any signs of abnormality in your physical check-up, you may need more detailed tests. These additional tests could involve procedures like an electroencephalography (a test that monitors the electrical activity in your brain), a brain CT scan, an electrocardiography (a test that measures your heart’s activity), tests for infection, arterial blood gas analysis (a test that measures oxygen and carbon dioxide levels in your blood), chest x-rays, and additional thyroid function tests.
Treatment Options for Anxiety
If you are experiencing a bout of intense anxiety, you may need medication called a benzodiazepine. For chronic or long-term anxiety, a combination of talk therapy (psychotherapy) and medication (pharmacotherapy) is often recommended.
There are numerous medications used to treat anxiety disorders. These include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, tricyclic antidepressants, mild tranquilizers, and beta-blockers.
SSRIs, which include fluoxetine, sertraline, paroxetine, escitalopram, and citalopram, have been found to effectively treat all kinds of anxiety disorders. They are typically the first choice for treatment. SNRIs, namely venlafaxine and duloxetine, have been found to be equally effective as SSRIs and are also considered primary treatment choices, especially for generalized anxiety disorder (GAD).
Tricyclic antidepressants, such as amitriptyline, imipramine, and nortriptyline, can also be used to treat anxiety disorders. They do, however, come with some significant side effects.
Benzodiazepines, like alprazolam, clonazepam, diazepam, and lorazepam, are used for short-term anxiety management. These medications work quickly, providing relief within 30 minutes to an hour, so they are effective for sudden panic attacks or intense episodes of anxiety. However, with prolonged use, you may need to take a higher dose to achieve the same effect. This could potentially lead to issues such as dependency and addiction.
A mild tranquilizer called Buspirone, which is slower to take effect compared to benzodiazepines, can take about 2 weeks to start working. However, it has the advantage of causing less sedation and has minimal risk of addiction with few withdrawal symptoms. It is helpful for generalized anxiety disorder.
Beta-blockers like propranolol and atenolol help manage physical symptoms of anxiety such as rapid heart rate, trembling voice, sweating, dizziness, and shaky hands. They are especially helpful for individuals with specific phobias, particularly social phobia.
In terms of psychotherapy, cognitive-behavioral therapy is one of the most effective methods. This therapy has a structured approach that helps individuals recognise and change the negative thinking patterns and beliefs that fuel their anxiety. It also focuses on helping patients develop better behavioral skills so they can respond more effectively to anxiety-inducing situations. Another type of therapy, exposure therapy, gradually exposes individuals to the situations and stimuli they usually avoid. This method helps reduce anxiety symptoms as individuals realize their fears are exaggerated, and they can effectively cope with these situations.
What else can Anxiety be?
- Pheochromocytoma (a rare tumor of adrenal gland tissue)
- Asthma (a condition that makes breathing difficult)
- Atrial fibrillation (an irregular and often fast heartbeat)
- Hyperthyroidism (overactive thyroid gland)
- Alcoholism (addiction to alcohol)
- Delirium (an abrupt change in the brain that causes mental confusion)
- Diabetic ketoacidosis (a serious complication of diabetes caused by lack of insulin)
- Substance abuse (use of drugs or alcohol in a way that leads to significant problems)
What to expect with Anxiety
Anxiety disorders can lead to severe health issues such as substance abuse, alcohol addiction, and severe depression. Moreover, constant anxiety can increase the chances of negative heart-related events. In some people, anxiety can make it difficult to form social relationships and can negatively impact their quality of life. High levels of anxiety have also been associated with a higher risk of suicide.
