You hit the deadline. You remember birthdays. You show up early. You get compliments for being “so on top of it.” And still – your stomach is tight, your mind is racing, and relaxing feels strangely unsafe. That’s the confusing reality many people describe as high-functioning anxiety. It’s not a formal diagnosis you’ll find in the DSM, but it’s a very real lived experience: anxiety that hides behind performance, productivity, and competence. From the outside, you look fine. On the inside, it can feel like you’re powered by pressure – and you’re one misstep away from falling apart………Continue reading….
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Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person’s social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.
In casual discourse, the words anxiety and fear are often used interchangeably. In clinical usage, they have distinct meanings; anxiety is clinically defined as an unpleasant emotional state for which the cause is either not readily identified or perceived to be uncontrollable or unavoidable, whereas fear is clinically defined as an emotional and physiological response to a recognized external threat. The umbrella term ‘anxiety disorder’ refers to a number of specific disorders that include fears (phobias) and/or anxiety symptoms.
There are several types of anxiety disorders, including generalized anxiety disorder, hypochondriasis, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. Individual disorders can be diagnosed using the specific and unique symptoms, triggering events, and timing of a given person. A medical professional must evaluate a person before diagnosing them with an anxiety disorder to ensure that their anxiety cannot be attributed to another medical illness or mental disorder.
It is possible for an individual to have more than one anxiety disorder during their life or to have more than one anxiety disorder at the same time. Anxiety disorders are the most common type of mental disorder. They affect nearly 30% of adults at some point in their lives, with an estimated 4% of the global population currently experiencing an anxiety disorder. However, anxiety disorders are treatable, and a number of effective treatments are available. Most people are able to lead normal, productive lives with some form of treatment.
Generalized anxiety disorder (GAD) is a common disorder characterized by long-lasting anxiety that is not focused on any one object or situation. Those with generalized anxiety disorder experience non-specific persistent fear and worry and become overly concerned with everyday matters. Generalized anxiety disorder is “characterized by chronic excessive worry accompanied by three or more of the following symptoms:
Restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance”. Generalized anxiety disorder is the most common anxiety disorder to affect older adults. Anxiety can be a symptom of a medical or substance use disorder problem, and medical professionals must be aware of this. A diagnosis of GAD is made when a person has been excessively worried about an everyday problem for six months or more. These stresses can include family life, work, social life, or their own health.
A person may find that they have problems making daily decisions and remembering commitments as a result of a lack of concentration and/or preoccupation with worry. A symptom can be a strained appearance, with increased sweating from the hands, feet, and axillae, along with tearfulness, which can suggest depression. Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes.
In children, GAD may be associated with headaches, restlessness, abdominal pain, and heart palpitations. Typically, it begins around eight to nine years of age. The largest category of anxiety disorders is that of specific phobias, which includes all cases in which fear and anxiety are triggered by a specific stimulus or situation. Between 5% and 12% of the population worldwide has specific phobias. According to the National Institute of Mental Health, a phobia is an intense fear of or aversion to specific objects or situations.
Individuals with a phobia typically anticipate terrifying consequences from encountering the object of their fear, which can be anything from an animal to a location to a bodily fluid to a particular situation. Common phobias are flying, blood, water, highway driving, and tunnels. When people are exposed to their phobia, they may experience trembling, shortness of breath, or rapid heartbeat. People with specific phobias often go to extreme lengths to avoid encountering their phobia. People with specific phobias understand that their fear is not proportional to the actual potential danger, but they can still become overwhelmed by it.
With panic disorder, a person has brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, or difficulty breathing. These panic attacks are defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes but can last for several hours. Attacks can be triggered by stress, irrational thoughts, general fear, fear of the unknown, or even when engaging in exercise. However, sometimes the trigger is unclear, and attacks can arise without warning.
To help prevent an attack, one can avoid the trigger. This can mean avoiding places, people, types of behaviors, or certain situations that have been known to cause a panic attack. This being said, not all attacks can be prevented. In addition to recurrent and unexpected panic attacks, a diagnosis of panic disorder requires that said attacks have chronic consequences: either worry over the attacks’ potential implications, persistent fear of future attacks, or significant changes in behavior related to the attacks.
As such, those with panic disorder experience symptoms even outside of specific panic episodes. Often, normal changes in heartbeat are noticed, leading them to think something is wrong with their heart or they are about to have another panic attack. In some cases, a heightened awareness (hypervigilance) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life-threatening illness (i.e., extreme hypochondriasis).
Agoraphobia is a specific anxiety disorder wherein an individual is afraid of being in a place or situation where escape is difficult or embarrassing or where help may be unavailable. Agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. In addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that individuals often develop.
For example, following a panic attack while driving, someone with agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can have serious consequences and often reinforce the fear they are caused by. In a severe case of agoraphobia, the person may never leave their home. Social anxiety disorder (SAD), also known as social phobia, describes an intense fear and avoidance of negative public scrutiny, public embarrassment, humiliation, or social interaction.
This fear can be specific to particular social situations (such as public speaking) or it can be experienced in most or all social situations. Roughly 7% of American adults have social anxiety disorder, and more than 75% of people experience their first symptoms in their childhood or early teenage years. Anxiety often manifests specific physical symptoms, including blushing, sweating, rapid heart rate, and difficulty speaking.
As with all phobic disorders, those with social anxiety often attempt to avoid the source of their anxiety; in the case of social anxiety, this is particularly problematic, and in severe cases, it can lead to complete social isolation. Children are also affected by social anxiety disorder, although their associated symptoms are different from those of teenagers and adults. They may experience difficulty processing or retrieving information, sleep deprivation, disruptive behaviors in class, and irregular class participation.
Social physique anxiety (SPA) is a sub-type of social anxiety involving concern over the evaluation of one’s body by others. SPA is common among adolescents, especially females.Post-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to trauma- and stressor-related disorders in the DSM-V) that results from a traumatic experience. PTSD affects approximately 3.5% of U.S. adults every year, and an estimated one in eleven people will be diagnosed with PTSD in their lifetime.
Post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying, or even a serious accident. It can also result from long-term (chronic) exposure to a severe stressor— for example, soldiers who endure individual battles but cannot cope with continuous combat. Common symptoms include hypervigilance, flashbacks, avoidant behaviors, anxiety, anger, and depression.
In addition, individuals may experience sleep disturbances. People who have PTSD often try to detach themselves from their friends and family and have difficulty maintaining these close relationships. There are a number of treatments that form the basis of the care plan for those with PTSD; such treatments include cognitive behavioral therapy (CBT), prolonged exposure therapy, stress inoculation therapy, medication, psychotherapy, and support from family and friends.
Post-traumatic stress disorder research began with US military veterans of the Vietnam War, as well as natural and non-natural disaster victims. Studies have found the degree of exposure to a disaster to be the best predictor of PTSD.
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