Understanding Anxiety

co-occurring disorders, anxiety, anxiety disorders

Anxiety is a nearly universal human experience that becomes so acute for some people that it takes over their lives. When you become so anxious that you can’t do the things you want to do, your anxiety has reached a clinical level and requires treatment. Getting evaluated for an anxiety disorder is the first step to understanding what you need to do to get your life back.

What Is Anxiety?

Fear, anxiety, and aversion are natural responses to stressors and unstable environmental conditions. In healthy people, anxiety is fleeting and does not continue after a stressor is no longer present, or an environment has changed. For example, a severe storm might fill people with worry that their homes could be damaged or that other people could be hurt. When the storm is over, though, and the aftermath is assessed, these worries usually fade.

However, for people with maladaptive anxiety, the sense of unease persists long after the storm has gone. People with the most severe anxiety disorders feel as if they are never safe and that their lives and well-being are constantly under threat. Others experience a more nebulous sense of unease. They believe that if something can go wrong, it will, and devote a lot of mental effort to planning for certain disaster.

Types of Anxiety Disorders

Clinicians have traditionally listed adult anxiety disorders as falling under one of five or six types:

  • Panic disorders
  • Specific phobias
  • Social anxiety disorder
  • Generalized anxiety disorder
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)

In 2013, with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), OCD and PTSD were re-classified as unique disorders rather than as anxiety disorders, though they are still recognized as extreme manifestations of anxiety.

Panic disorder is defined by the experience of recurrent “panic attacks.” These extreme surges of anxiety include physical symptoms like spikes in heart rate and shortness of breath. Sufferers commonly experience an intense sense of doom or fear of impending death along with these symptoms. Panic attacks can occur in response to specific triggers or can arise unexpectedly.

Specific phobias are intense, specific fears of particular objects or situations. While people who suffer from phobias often fear things that are dangerous, what makes their fear a phobia is that it is out of proportion to the actual danger they are in. Phobias also drive irrational behavior that puts people at increased risk of harm. Whether a person seeks treatment for a phobia often depends on how frequently they encounter phobia-related triggers in their daily lives.

Social anxiety disorder (SAD), also known as social phobia, involves an intense fear of social situations. People with SAD are primarily afraid that they will be negatively judged or rejected for how they perform during social encounters. Among other things, they fear the signs of their anxiety will cause them to be shunned or excluded by others. The fear of humiliation is so great that people with SAD prefer to isolate themselves rather than risk it.

Generalized anxiety disorder (GAD) is less tied to specific triggers than any of the other anxiety disorders. People with GAD often worry about a vast array of things, but this is more of a result than a cause of their anxiety. It’s as if they are trying to figure out why they feel like something is always about to go wrong. As a result of this constant worry, they may suffer from a host of related symptoms, including muscle tension, restlessness, and insomnia.

Obsessive-compulsive disorder (OCD) is a disorder in which people respond to anxiety-provoking obsessions by engaging in compulsive actions. This means they try to control intrusive, unwanted thoughts or urges with repetitive external or internal behaviors. For example, a person obsessed with contamination might repeatedly wash their hands, while a person with a recurring intrusive thought of wanting to hurt someone might count to a specific number every time they have that thought to make it go away.

Post-traumatic stress disorder (PTSD) occurs when the natural, adaptive stress that arises in the wake of traumatic events persists long after those events are over. Intrusive symptoms include flashbacks, nightmares, and traumatic memories. People with PTSD may experience emotional numbing and dissociative reactions or become more physically and emotionally reactive in response to these intrusive symptoms. To avoid these reactions, they go to great lengths to avoid anything that reminds them of the trauma they experienced.

The main feature of all of these conditions is that the distress caused by the symptoms is severe and that it interferes with a person’s ability to function in everyday life.

Anxiety and Addiction

Many kinds of anxiety co-occur with addiction. Often, people abuse substances as a way to cope with unresolved psychological issues, which may include underlying anxiety disorders. Anxiety also arises as an effect of substance abuse. Some substances, like methamphetamines, synthetic drugs, and marijuana, can provoke anxiety along with other more desired effects.

Anxiety is extremely common as part of “coming down,” or entering the withdrawal phase of substance dependence. Since most drugs mimic or interact with natural neurotransmitters, the brain makes less of these natural chemicals or becomes less responsive to them in response to being flooded with chemically similar substances on a regular basis. These changes in the brain result in more frequent and intense episodes of anxiety.

It’s not uncommon to hear that “addiction is a family disease.” This is because family members often suffer similar ups and downs as loved ones with substance use disorders. One of the most common ailments shared between addicts and their family members is anxiety. While addicts may worry about how to maintain access to a substance or about the consequences of their use, family members worry about the danger their loved ones are facing.

Treatment for Anxiety

When anxiety is triggered by an unhealthy behavior, the easiest way to experience relief is to discontinue the behavior. For example, long-term substance abuse changes the brain in ways that increase anxiety, but the brain naturally heals and returns to prior levels of functioning during periods of sustained abstinence from substance use. Using resources like treatment programs and support groups can help a person maintain the life changes required to heal.

When anxiety arises from an underlying anxiety disorder, it is important to seek treatment for the disorder. Whether medications are used depends on the particular disorder and a person’s history and individual needs. For example, many anti-anxiety medications are contraindicated for people in recovery due to their addictive properties or for people with comorbid medical or mental health conditions that would be aggravated by anxiolytic medications.

Talk therapy is commonly recommended for people with anxiety disorders, especially cognitive-behavioral therapy (CBT). This goal-driven technique focuses on identifying irrational thoughts that trigger painful feelings and unwanted behaviors. By helping people learn how to counter harmful beliefs, CBT helps them reduce associated emotional pain and unwanted behavior.

Patients with histories of trauma may want to complement CBT with methods that address deeper causes of emotional pain. Psychodynamic and depth therapy untangle issues rooted in childhood experiences. Eye Movement Desensitization and Reprocessing (EMDR) is increasingly popular and particularly effective for treating pain and anxiety that stem from trauma.

In addition to formal treatment, anxiety is particularly responsive to behavioral interventions. Dietary changes that can reduce anxiety include reducing caffeine and sugar consumption and increasing intake of healthy fats and probiotic foods. Exercise is also especially helpful. Gentle yoga promotes relaxation and body awareness, while vigorous aerobic exercise discharges tension and releases brain chemicals that counteract anxiety. Reading books, engaging in creative activities, and walking in nature have all been shown to reduce anxiety.

Conclusion

If you or a loved one are suffering from clinical anxiety, you are not alone. Every year, over 40 million adults in the United States meet the criteria for one or more anxiety disorders. Yet only a third of people suffering from these conditions get treatment. This is especially unfortunate since anxiety responds so well to a wide range of interventions. Anxiety can be overcome; please reach out and start the journey to recovery today.

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