Anxiety disorders are well known the be the most commonly diagnosed mental health disorders. Anxiety itself, however, is not a disorder. Anxiety is a feeling or emotion meant to signal danger, and therefore should be considered a survival mechanism. It is essentially the semantic equivalent of “stress” and is an important criteria in every psychiatric assessment because of its potential for causing psychological dysfunction. Many individuals are unaware of the central role that anxiety plays in much of their day to day thinking and behaviors.
Physiological manifestations of anxiety
Anxiety has been linked to the amygdala, which is a component of the limbic system. This system is integral in memory and emotion processing. Because the amygdala is closely linked to other important structures in the brain, anxiety has the potential to affect other body systems and functions.
One of these closely linked structures is the hypothalamus, which is the main regulator of homeostatic functions in the body, including sleep, appetite, mood, libido, heart rate, blood pressure, and more. Gastrointestinal complaints, including cramping, nausea, vomiting, appetite issues, and sometimes diarrhea are very common anxiety related complaints and can be severe for some individuals. Many individuals have a difficult time acknowledging that these symptoms are associated with anxiety, possibly due to symptom severity, as well as anxiety’s inherent tendency to mislead as pertaining to its source.
Sleep disturbances are also common and often is among the first manifestations of problematic anxiety. Excessive and unrelieved anxiety can also lead to mood instability, including issues with depression, and mania in some individuals. Increased or unmanageable anxiety may also lead to panic attacks.
Cognitive and Behavioral manifestations of anxiety
High anxiety may also lead to increased monitoring of internal states. Some individuals may become obsessively focused on bodily sensations and functions when anxiety is high, immediately noting and worrying about perceived abnormalities. This can lead to symptoms of somatization disorder if the intensity and duration is excessive. The limbic system is actually a “monitoring” system in some respects, so when anxiety is high, alertness and monitoring for threats increases. Formerly called hypochondriasis, or “hypochondriacs”, the term “somatically focused” is now generally used to describe individuals who exhibit this kind of internal hypervigilance.
Anxiety often leads to a powerful urge to try to control situations and outcomes. Many individuals are unaware of these controlling tendencies. They may try excessively to control themselves, others, situations, outcomes, etc. These attempts to control may lead to poor or worse outcomes. Anxiety can also lead to cycles of fear, obsessive thinking, and compulsions. See the section on OCD for more information. A few common cognitive sources of anxiety include difficulty tolerating uncertainty, fear of social rejection, feeling responsible for the decisions and welfare of others, among others.
Cognitive distortions are a troubling manifestation of anxiety and can vary in their intensity, duration, rationality, and impact. In the context of anxiety, a cognitive distortion is a belief or fear which arises out of the person’s anxious state, or in other words, is a distressing idea or belief which the person would not otherwise believe so readily if they were not in a state of high anxiety. Increasing awareness of cognitive distortions and panic states is important for managing anxiety. Many individuals report visits to emergency rooms, and subsequently finding out they were having a panic attack.
Worrying and avoidance are two problematic responses to anxiety, and ultimately lead to increased anxiety. Avoiding things, places, people, etc. which trigger anxiety sends a message to the brain that the thing avoided is worthy of anxiety and should continue to be feared. The brain learns that it needs to continue propagating these anxious signals each time the fearful thing is avoided, and the signals may become stronger over time. This is useful if the dreaded thing presents a real danger to wellbeing, but in actuality this may not be the case. Phobias, past trauma, and OCD in particular may need exposure therapy in order to rewire the brain to become desensitized to anxiety inducing triggers. See the section on OCD for more information on exposure therapy.
Substance Use and Anxiety
Substance use is an essential consideration when evaluating the source of an individual’s anxiety. Substances which are especially problematic are often the very substances which are being used to manage, or “self-medicate” anxiety. At the top of the list are alcohol and benzodiazepines, such as Xanax, Ativan, etc. Both substances are very similar and can lead to a dangerous situation over time when excessive use leads to tolerance, dependence, and possibly addiction. Withdrawal may need to be medically supervised.
There is sufficient data to conclude that marijuana use over time can lead to increased anxiety. Caffeine is a stimulant which will produce anxiety. Nicotine also will likely lead to increased anxiety over time. Stimulants such as amphetamine and and methylphenidate will produce anxiety, and ultimately paranoia if too much is being consumed. There is a general rule with substance abuse, that whatever symptom is being treated through the abuse of a substance will likely become worse over time. Any substance or behavior which has an immediate and potent impact on mental and emotional wellbeing will produce tolerance, dependence, and possibly addiction over time if the substance is being used regularly to cope with the stress of life.
Anxiety Treatment
Medication, therapy, and self-help education can be effective in decreasing anxiety. For some individuals, anxiety arises out of self esteem difficulties and manifests as a fear of social rejection. These self esteem difficulties may or may not be associated with trauma. Therapy can be very important in this situation. Medication will not fix self-esteem induced anxiety issues. It may help for a time, and can be useful for individuals while undergoing therapy, but the anxiety will ultimately continue to surface if the underlying cause is not treated. See the subheading SHAME under the ADDICTION tab for a deeper dive into self esteem issues.
For others, traumatic or difficult relationship experiences may lead them to feel responsible for the wellbeing of others. They may compulsively try to help or rescue, and worry constantly about others’ wellbeing. Anxious individuals may also worry frequently about the future and may “catastrophize”, or worry constantly that the worst possible outcome will be the result of stressful situations. Therapy may be helpful for both of these tendencies.
Medication can be helpful in treating anxiety. There are a number of different types of medications which can be used, including medications taken daily to stabilize one’s mood, and others which can be taken as needed to help in anxious moments. Often, improving one’s sleep, or stabilizing their mood will lead to better anxiety management. Remember that our thoughts affect our feelings and moods, but also that our feelings and moods can affect our thoughts.
Situational stress reduction can be helpful for improving one’s anxiety. Working too many hours at a stressful job, financial worries, relationship difficulties, problems in school, etc. can all have an impact on anxiety. Therapy can be helpful for increasing one’s adaptability to stressful situations, and medication can be useful in helping people through difficult times. Affirmational mantras such as, “Even if the worst does happen, I can make it through this”, “my self worth isn’t dependent on my circumstances”, “I don’t need to catastrophize”, and others, can help to counteract anxious thoughts and feelings.
Interpersonal connection is also a powerful way to help manage anxiety. Sharing stressors and worrisome thoughts and fears with supportive persons can be helpful in reducing the obsessive worry and alleviating feelings of anxiety. It can be helpful to talk through anxious thoughts and process them, because in the presence of strong emotion thinking can become distorted. In some cases, however, such as in OCD, where the stressor is an intensely feared obsession, discussing the obsessions in detail can trigger increased anxiety. In PTSD, talking about trauma is often an essential part of recovery, but should be done in a supportive environment, possibly with a therapist who can help recognize and deescalate intense emotional triggers.
Anxiety, however, can also be important and useful. Anxious people may be relatively more on top of important responsibilities. Many anxious people perform well at school and work, and getting things done in general because their anxiety motivates them to complete their tasks. One should be aware, however, that this tendency is often associated with perfectionism. When excessive, perfectionism can get in the way of producing and/or finishing good work because it is “never good enough”. The dedication and exertion employed when motivated by perfectionism can be excessive and lead to burnout, depression, and increased feelings of worthlessness. Again, see the subheading SHAME under the ADDICTION tab for a deeper dive. There are also many helpful books and accomplished authors, such as Brené Brown, who have written extensively on shame and how to treat and manage it through vulnerability and connection.
Whatever the source of anxiety, there is treatment for it. Even if the source of anxiety is due to severe trauma symptoms, OCD, phobias, and is complicated by other mental health issues, it can be treated and better managed. A better quality of life is attainable for those who struggle with anxiety. Medications can be very helpful for some individuals. Some individuals also draw strength from faith and spirituality as well, finding a sense of self worth, perspective, and sometimes assurances that all will be well. Above all, don’t give up! Your mental health journey can reap beneficial rewards if you continue diligent and remember that anything worth having takes time, effort, and patience!
