What is Anxiety?
Anxiety is the body and mind's natural reaction to threat or danger. Commonly referred to as the ‘Fight or Flight' response, the body releases hormones such as adrenaline, which in turn results in a number of physiological reactions occurring in the body. These emotions help us to survive by ensuring that we are alert and responsive to the danger.
In the appropriate situation, high levels of anxiety - even panic - is considered normal and helpful if it prompts us to escape from danger. Anxiety in performance situations such as interviews and exams can help us perform to the best of our ability. The problems arise when people's response (anxiety) is out of proportion to the actual danger of the situation, or that it is generated when there is no danger present.
Anxiety is something we all experience from time to time. However, when anxiety becomes excessive or debilitating then it is considered an Anxiety Disorder.
Over the last few decades there has been a dramatic improvement in our understanding of anxiety and how it can be treated.
Types of Clinical Anxiety
Anxiety can be the main or "primary" problem or it can be a secondary problem which means that it is a symptom of another disorder. Depression and substance or alcohol misuse are often associated with high levels of anxiety, but in these cases lasting benefit will come from treating the underlying problem rather than focusing solely on the anxiety symptoms.
In primary anxiety disorders the symptoms tend to have followed a set pattern over several months or years. In these cases the anxiety symptoms occur independently of other mental health problems, however they can be intensified when coupled with depression and life stress.
How common are Anxiety Disorders?
Anxiety disorders are the most common mental health problem along with depression, affecting the population of Ireland and Europe. They account for a similar level of stress and disability within society as cancer or heart disease.
There are no accurate figures detailing the prevalence of anxiety disorders in Ireland. It is estimated that 1 in 9 individuals will suffer a primary anxiety disorder over their lifetime. Only a fraction of these individuals receive appropriate treatment which is a great pity as it has been demonstrated consistently that with expert therapy the majority of sufferers can achieve a lasting improvement.
Anxiety disorders are not age specific. The age of onset is quite variable ranging from childhood and adolescence to adulthood.
Frequently anxiety disorders are associated with other anxiety disorders, for example agoraphobia combined with panic disorder. There is also the association between anxiety disorders and other disorders, such as depression, substance/alcohol misuse.
Causes of Anxiety Disorders
Anxiety can be primary or secondary to other mental health problems such as depression or substance misuse. Primary anxiety disorders are thought to result from a combination of genetic predisposition and life stress triggering a vicious cycle.
Physiological reactions in the brain and body, distorted thoughts and beliefs about risk and danger and patterns of behaviour, such as avoidance or safety seeking, all interact to develop and maintain the problem.
Features of anxiety disorder:
- Altered physical sensations - palpitations, nausea
- Altered thoughts - irrational thinking, worry
- Altered behaviour - restless, avoidance
- Altered emotions - fear, panic
(British Association for Behavioural and Cognitive Psychotherapies, 2002)
Panic attacks are extremely frightening. They may appear to come out of the blue, strike at random and make people feel powerless, that they are losing control and about to die.
A panic attack is really the body's way of responding to the "flight or fight" response system getting triggered without the presence of an actual external threat or danger. When adrenalin floods the body, it can cause a number of different physical and emotional sensations that may affect people during a panic attack. These may include;
- very rapid breathing or feeling unable to breathe
- palpitations, pounding heartbeat
- chest pain
- dizziness, light-headed or faint
- ringing in the ears
- hot or cold flushes
- fear of losing control
- fear of dying
Panic disorder is sudden episodes of acute severe anxiety/panic associated with a fear of death or collapse. The key feature of the disorder is the sudden onset, occurring "out of the blue", with no identifiable trigger. It can be accompanied with a persistent concern about future attacks and consequences of the attack (losing control).
It is commonly associated with agoraphobia. Approximately 20% people will experience at least one panic attack at some time in their lives.
Prolonged panic disorder can lead to agoraphobia, a condition defined by anxiety/fear about being in situations from which escape might be difficult or embarrassing in the event of suddenly developing a panic attack or panic-like symptoms, or where help is not readily available. Examples of such situations include:
- Going outside of home alone
- Crowded public places, e.g. department stores, restaurants
- Public transportation, e.g. trains, planes, buses
- Enclosed or confined spaces such as tunnels, lifts
In turn there may also be excessive worry about loss of control, socially inappropriate behaviour and physical illness such as a heart attack, fainting and of dying. People's anxiety levels rise from anticipating that they might be stuck in a situation where they would panic.
This results in avoidance of a whole range of situations and day-to-day activity, and in some cases, people may become housebound or confined to a small "safe" area.
It is estimated that probably 1% of the population suffer agoraphobia that causes significant impairment to their daily functioning and about 5% suffers from varying degrees of agoraphobia.
Social anxiety presents as excessive anxiety and self-consciousness in social situations with a central fear of being judged negatively or harshly or appearing foolish. It leads to avoidance of social or performance situations such as public speaking as well as subtle forms of hiding away in social gatherings.
Even though the fear and anxiety are recognised as being excessive, social and performance situations are avoided or are endured with extreme anxiety and distress.
More than one in eight people will suffer from the disorder at some point in their lives. The onset is most frequent in mid-teens, but can occur at any time. Symptoms manifest themselves physically and can include blushing, sweating and palpitations.
People with social phobia may:
- View small mistakes as more exaggerated than they really are.
- Find blushing as painfully embarrassing.
- Feel that all eyes are on them.
- Fear public speaking, dating, or talking with persons in authority.
- Fear using public restrooms or restaurants.
- Fear of talking on the phone or writing in front of others.
Obsessive Compulsive Disorder
Obsessive Compulsive Disorder (OCD) is the name given to a condition in which people experience repetitive and upsetting thoughts and/or behaviours. OCD has two main features: Obsessions and Compulsions.
Obsessions: they come in the form of intrusive, unwanted involuntary thoughts, images or impulses. The main features of obsessions are that they are automatic, frequent, or distressing and difficult to control or get rid of.
Common obsessions include:
- Fears of getting a disease, e.g. cancer, AIDS
- Fears about dirt, germs and contamination
- Fear of acting out violently or aggressive thoughts/impulses
- Fears of harming others, especially a loved one
- Inordinate concern with order, arrangement or symmetry
- Fears that things are not safe, especially household appliances
Compulsions: commonly called "rituals". They are repetitive, purposeful behaviours preformed in a response to an obsession or according to certain rules. In some cases, people have compulsions without having obsessional thoughts, but very often, they occur together. Carrying out a compulsion reduces the person's anxiety, however, the anxiety relief is usually short lived, and makes the urge to perform the compulsion again stronger each time.
Common compulsions include:
- Excessive washing or cleaning, e.g. hand washing
- Repetitive actions, e.g. touching, counting
- Arranging and ordering, e.g. objects in a room
- Hoarding or saving things
OCD is a complex disorder that can be tremendously disruptive to sufferers and their families. Sufferers have an exaggerated sense of responsibility for preventing harm and have a heightened awareness of risk and danger.
It is estimated that approximately 1% of the population suffer from OCD at some point in their lives. OCD can start at any time from preschool age to adulthood, with the typical age of onset being during adolescence or early childhood.
Generalised Anxiety Disorder
This is a disorder of uncontrolled worrying. Sufferers spend long periods agonising over what they anticipate might go wrong in the future. GAD is one of the most common anxiety disorders, affecting 2-8% of the population. The age of onset is quite variable, ranging from childhood to adulthood.
Symptoms include distress, sleep disturbance, difficulty concentrating and exhaustion. Unlike obsessive compulsive disorder, there are fewer neutralising acts or compulsions and the fear tends to spread across numerous everyday themes rather than fixating on specific dangers.
The worry and anxiety cause significant distress and impairment in functioning, interfering with a person’s social, occupational or routine functioning.
Post Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) is a psychological reaction that develops following exposure to an overwhelming, frightening or traumatic event. It is a carefully defined disorder that results from a trauma such as a road traffic accident or an assault. PTSD is characterised by three main groups of problems and they can be classified under the headings: intrusive, avoidant and arousal symptoms.
Symptoms include distressing memories and flashbacks of the event, avoidance of any reminders of the event, withdrawal from others, increased vigilance and sleep disturbance.
Traumatic events that can trigger PTSD include natural disasters such as earthquakes or tornadoes, motor vehicle or other accidents, military combat and violent personal assaults e.g. mugging.
It is important to distinguish the disorder from normal reactions to traumatic events, which are similar but shorter lived and less intense.
The Anxiety Disorders Service will assess PTSD and will treat individual PTSD but it is not part of the Anxiety Disorders Programme.
A specific phobia is an intense fear of a particular object or situation that poses little or no actual danger. Often present from childhood, these are intense automatic fears of triggers such as rats, spiders, heights, enclosed spaces or more unusually vomiting or thunderstorms. They are associated with an intense desire to avoid or escape from the trigger. It affects approximately 10% of the population.
The fear and avoidance are strong enough that it significantly interferes with the person’s normal routine, academic or occupational functioning, social activities or relationships, or there is marked distress about having the phobia.
Most common specific phobias:
- Claustrophobia - fear of closed spaces
- Aquaphobia - fear of water
- Animal phobias can include; snakes, bats, rats. Herpetophobia - fear of reptiles/crawling things(spiders)
- Acrophobia - fear of heights
- Blood - injury phobia
- Illness phobia - fear of contracting and/or succumbing to a specific illness, e.g. heart attack, cancer
Cognitive Behaviour Therapy treatments are highly effective in anxiety disorders and target exaggerated danger beliefs and safety behaviours in a collaborative way with the aim of breaking the vicious cycle and helping the sufferer achieve greater confidence in the face of what they fear.
By learning about the vicious cycle of anxiety and by challenging beliefs and behaviours at the centre of the anxiety problem, sufferers gradually master their fears and regain their functioning.
CBT work can be greatly supported by meditational strategies such as mindfulness meditation, occupational therapy and various drug treatments. Serotonin boosting anti-depressant drugs are very helpful in easing anxiety states and combine nicely with CBT work.
Sedative anti-anxiety drugs can also be used in the short term to ease the worst of the anxiety during the acute phase. Best results are achieved by carefully focused Cognitive Behaviour Therapy combined with other forms of help as needed.
Our Anixety Disorders Service provides care in an outpatient, day-patient or inpatient setting according to the needs of the individual.
Overcoming Anxiety - Helen Kennerley
Overcoming Body Image Problems including Body Dysmorphic Disorder -David Veale, Rob Willson and Dr Alex Clarke
Overcoming Obsessive Compulsive Disorder - David Veale & Rob Willson
Overcoming Panic - Derrick Silove & Vijaya Manicavasagar
Overcoming Perfectionism - Roz Shafran, Sarah Egan & Tracey Wade
Overcoming Social Anxiety & Shyness - Gillian Butler
Overcoming Traumatic Stress - Claudia Herbert and Ann Wetmore
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