A N X I E T Y. Most people don’t even bat an eye when they hear this term- its become so mainstream and normalized. Although many people experience some form of anxiety- whether it be with a looming work deadline or trying to pay bills on time- there is more to anxiety than meets the eye.
Below, I will give an overview of anxiety, categorized by the following sections:
- The Causes of Anxiety
- Different Types of Anxiety Disorders
- Anxiety’s Affect on the Brain and Body
- Experiencing Anxiety
- Treatment Options
- Coping Strategies
- Conclusion
Causes of Anxiety: An Etiology
According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (a.k.a the DSM-5), which is the most up to date diagnostic manual used widely by qualified mental health professionals, anxiety is defined as “the anticipation of future threat,” whereas fear is defined as, “ the emotional response to real or perceived imminent threat.” Therefore, anxiety disorders are the result of behavioral responses to anxiety and pervasive fear, which typically leads to impaired functioning.
Anxiety can be caused by a multitude of factors. Below I have categorized examples of possible causes of anxiety, organized, from what I consider to be, lower in severity to higher in severity:
- Personality- Shyer or more reserved temperament, originating in childhood; perfectionism, whether innate or influenced by environmental factors (e.g. through child rearing)
- Diet- Foods filled with high amounts of sugar, additives, caffeine, and gluten (more so if an individual has a gluten sensitivity) have been suggested to contribute to anxiety symptoms. See also A Holistic Perspective, within the Anxiety’s Affect on the Brain and Body section
- Daily Life Stressors- This may include work or school performance, finances, relationship difficulties, concerns for the health and wellbeing of self and loved ones, external/environmental factors (e.g. living conditions); these typically are primary life stressors
- Genetics- predisposition to anxiety or other mental health conditions, from maternal or/ and paternal sides of the family
- Family dynamics- if there is an insecure attachment (i.e. weak or inconsistent bond) between child and attachment figures (i.e. parents, caregivers). See Attachment theory in the References section for more information
- Medical conditions- Specifically with the thyroid or heart arrhythmias, or side effects of medications or drugs/substances, such as high amounts of caffeine. Because these conditions can cause or imitate symptoms of anxiety/ other mental health conditions, they are typically ruled out when trying to determine if an individual is suffering from a specific mental health condition.
- Distressing/Traumatic events- events that negatively impacted an individual, whether in childhood or/and adulthood.
Some anxiety may be experienced as temporary or ongoing; however what sets anxiety disorders apart from merely experiencing anxiety, is the severity by which anxiety is experienced, paired with the duration of time. If anxiety is impairing one’s daily functioning to the degree that they are not able to participate in certain activities or complete ordinary tasks, and lasts for a long duration of time, the anxiety may fall into the disorder category (duration typically lasts between 1 to 6 months at minimum, depending on the anxiety disorder and age of onset.)
Types of Anxiety Disorders
There are 7 main types of anxiety disorders: Separation Anxiety Disorder, Selective Mutism, Specific Phobia, Agoraphobia, Social Anxiety Disorder, Panic Disorder, and Generalized Anxiety Disorder. The DSM-5 also lists additional anxiety disorders, such as Substance/ Medication- Induced Anxiety Disorder, Anxiety Disorder Due to Another Medical Condition, Other Specified Anxiety Disorder, and Unspecified Anxiety Disorder; these anxiety disorders are typically explored as a possible diagnosis, if an individual does not meet all of the criteria for the main types of anxiety disorders listed above. However, for the purposes of this blog, I will focus on the 7 main types of anxiety disorders. I will give a brief overview of the characteristics of each type of disorder, as well as the duration of time symptoms must occur, in order to be diagnosed.
Separation Anxiety Disorder
The DSM-5 characterizes this disorder as being “ fearful or anxious about separation from attachment figures to a degree that is developmentally inappropriate.” An individual is plagued by fear and anxiety that harm could happen to them or attachment figures (e.g. parents, caregivers, loved ones), causing the individual to be separated from attachment figures, whether temporarily, a long duration of time, or indefinitely (e.g. removal from the home, death). Some symptoms include continually refusing to go out in the community (e.g. to school or work), refusal to be alone, persistent physical symptoms (stomachaches, headaches, etc.), and persistent nightmares. This disorder typicallly afflicts children, but can be found in adults as well. Symptoms must last at least 4 weeks in children and teens, and 6 months in adults, in order for Separation Anxiety Disorder to be diagnosed.
Selective Mutism
The DSM-5 characterizes selective mutism as “a consistent failure to speak in social situations in which there is an expectation to speak (e.g. school) even though the individual speaks in other situations.” This typically impairs an individual’s work or school performance, as well as social interactions. Typically found in children, symptoms must occur for at least 1 month in order to be diagnosed, and is not found to be the result of a different communication or neurological disorder ( such as a speech and language impairment, or autism spectrum disorder).
Specific Phobia
The DSM-5 characterizes specific phobia as being “ fearful or anxious about or avoidant of circumscribed [restricting; limiting] objects or situations. The fear, anxiety, or avoidance is almost always immeasurably induced by the phobic situation, to a degree that is persistent and out of proportion to the actual risk posed.” Some of the phobias or phobic situations include flying, heights, injections or seeing blood, and animals. Symptoms include avoidance of a specific situation or object, immediately acting out in fear or anxiety when faced with the specific situation or object, and impaired functioning due to excessive fear or anxiety of the specific situation or object. Symptoms must occur for at least 6 months in order to be diagnosed.
Agoraphobia
The DSM-5 characterizes agoraphobia as being “fearful and anxious about two or more of the following situations: using public transportation; being in open spaces; being in enclosed spaces; standing in line or being in a crowd; or being outside of the home alone in other situations.” The fear and anxiety is produced if the individual believes that there would be no escape, or help available if they were to develop panic symptoms, or other similar symptoms. In addition to the above described symptoms, other symptoms include avoidance of agoraphobic situations; fear and anxiety being excessively disproportionate to the actual risk of harm caused by the situation and; impaired functioning due to excessive fear or anxiety of the agoraphobic situation. Symptoms must occur for at least 6 months, in order to be diagnosed.
I think it is important to note that the difference between agoraphobia and specific phobia, is the individual must demonstrate excessive fear/anxiety specifically in two or more situations in the agoraphobic category (i.e. standing in a line or a crowd, public transportation, going outside of the home alone, enclosed spaces, open spaces), in order to be diagnosed with agoraphobia.
Social Anxiety Disorder
The DSM-5 characterizes social anxiety disorder, also known as social phobia, as being “fearful or anxious about or avoidant of social interactions and situations that involve the possibility of being scrutinized. The cognitive ideation is of being negatively evaluated by others, by being embarrassed, humiliated, or rejected, or offending others.” Other symptoms include pervasive avoidance of social situations, and impaired functioning due to excessive fear or anxiety of social situations. If symptoms are not attributable to another disorder (i.e. autism spectrum disorder, panic disorder, or body dysmorphic disorder), and lasts for at least 6 months, then social anxiety disorder may be diagnosed.
Panic Disorder
The DSM-5 characterizes panic disorders as an individual who experiences “recurrent unexpected panic attacks and is persistently concerned or worried about having more panic attacks or changes his or her behavior in maladaptive ways because of the panic attacks (e.g. avoidance of exercise or of unfamiliar locations).” It is also important to add that the DSM-5 defines panic attacks as “abrupt surges of intense fear or intense discomfort that reach a peak within minutes, accompanied by physical and/or cognitive symptoms.” Panic attacks can happen while the individual is calm or anxious. There are many possible symptoms of panic disorder; however some of those symptoms include trembling/shaking, chest pain, dizziness/lightheadedness, feeling like one is choking, shortness of breath, and fear of dying. In addition to these symptoms, one (or more) of the experienced panic attacks are accompanied by at least one month of the following:
- Excessive worry about ongoing panic attacks or/and;
- Avoidance behaviors that interfere with functioning, in an effort to prevent the potential for panic attacks
If symptoms are not the result of a medical condition, substance/drug or medication, or another mental health disorder (e.g. a response to social situations from social phobia, or obsessions with regard to Obsessive- Compulsive Disorder), then Panic Disorder may be an appropriate diagnosis.
Generalized Anxiety Disorder
The DSM-5 characterizes generalized anxiety disorder as “persistent and excessive anxiety and worry about various domains, including work and school performance, that the individual finds difficult to control.” Symptoms include difficulty concentrating, restlessness, fatigue, sleep difficulties, muscle tension, and irritability. A diagnosis may be appropriate if:
- At least 3 of the 6 listed symptoms are present in adults (1 present in children), with a few ongoing for at least 6 months
- Impaired functioning due to excessive worry or anxiety
- Symptoms are not the result of a medical condition, substance/drug or medication, or another mental health disorder
For Your Consideration
Phew! We got through all of that info!
As you can see there are many types of anxiety disorders, and variances within each disorder type. Again, Anxiety isn’t a blanket statement, and there is a lot involved within that 7 letter term.
As mentioned previously in the Overview post, I am merely providing information, based on my professional experience and resources. I am in no way diagnosing anyone, nor am I suggesting that you diagnose yourself based the provided information. If you or a loved one are exhibiting the above symptoms and suspect that you or they are experiencing an anxiety disorder, please seek professional help from your physician (who may be able to provide a referral for a psychiatrist/psychologist), or from a trained mental health professional (i.e. psychiatrist, psychologist, counselor).
Additionally, as a social worker who previously worked in trauma, I would like to note that some symptoms characteristic of these anxiety disorders could also be characteristic of individuals (especially children and teens) who have experienced trauma- specifically physical or sexual abuse. I am not adding this to cause fear, but only to keep in consideration if you find that your child, teen, a loved one, or even yourself, are exhibiting these symptoms. My professional and personal opinion is to explore all options, because it is better to error on the side of caution in this situation. If you believe this could be a possibility, please have a discussion with the child/teen, asking if anyone has hurt them- it’s definitely not an easy conversation to have, but an important one. If you yourself have experienced a trauma, please seek professional help from your physician or trained mental health professional, and if appropriate report to the proper authorities. You are not alone and there is help out there!
Anxiety’s Affect on the Brain and Body
Alright, now for a mini biology lesson on the brain!
The primary areas of the brain that are most affected by anxiety are the amygdala (i.e. the red almond-like structure in the diagram) and the hippocampus (i.e. the green caterpillar like structure in the diagram.) The amygdala is basically the emotion center of the brain that triggers emotional responses if a threat is perceived, whether the threat is real or imagined. So, when you think of the fight, flight, freeze responses, the amygdala is the part of the brain that is responsible. The hippocampus is the part of the brain responsible for encoding sensory information (i.e. our experiences/events) and all emotional responses attached to it, into memories (i.e. the memory warehouse). So when the amygdala perceives a threat to the system, it will signal the release of adrenaline and hormones, such as cortisol (a.k.a the stress hormone) into the body, which causes that fight, flight, and freeze response.
Here is a scenario below, to get a sense of what this all may look like:
1) A child gets separated from their parent at the grocery store
2) After a few moments stress may set in; the amygdala will alert the brain that this situation is a threat, signaling the release of cortisol and other hormones, creating the survival mode “fight, flight, freeze” response
3) The hippocampus will record the separation event as a fearful memory. If this situation was particularly distressing or traumatic for the child, this may cause the child to experience high anxiety or fear if they are separated again from parents in the future, or at the thought about being separated from parents in the future.
Anxiety and Brain – https://directindia.org/resources/anxiety-and-the-brain/
Some people may process an event as a distressing experience, and be able to continue functioning normally. However, depending on how greatly impacted an individual is by a particular event or how frequently they are exposed to other causes of anxiety, it may lead to the development of an anxiety disorder.
Please see the diagram for a more comprehensive view of anxiety’s affect on the brain and body.
A Holistic Perspective
From a holistic perspective, foods high in sugar, caffeine, and gluten (more so, if you have an existing gluten sensitivity), have been suggested to contribute to anxiety symptoms in the brain and body. It is suggested that in high amounts, sugar and caffeine can cause physical changes/reactions (e.g. racing heart, shakiness) that the brain may interpret as a threat to system, causing a heightened anxious state. Additionally, it is suggested that for those with gluten sensitivities, gluten can cause inflammation in brain, through what is called the “gut-brain axis”, which is defined as the “bidirectional communication system between the enteric nervous system in the gut and the central nervous system in the brain and spinal cord,” (kresserinstitute.com). Although gluten has been linked to mental health conditions, I would strongly encourage everyone to do additional research on this subject.
Experiencing Anxiety
There are all kinds of causes of anxiety, and everyone experiences symptoms of anxiety differently. As I have mentioned in previous blog posts, I have a diagnosis of obsessive-compulsive disorder (OCD), which makes me prone to high anxiety often. I had my awesome artist friend, Adam, create artwork for this blog series. I really wanted him to illustrate how I and many others may experience anxiety: tightness in the chest- as if someone or something is pressing down on you; feelings of relentless panic that you can’t escape- like impending doom. Some of us wake up with that feeling and go to bed with it.
California Pediatrician, Nadine Burke Harris, famously known for her TED talk on Adverse Childhood Experiences (ACEs) shared a wonderful analogy about how we handle stress. She essentially stated that if you were in a forest and came across a bear, your fight or flight response (discussed in the anxiety’s affect on the brain and body section) would kick into gear, which is a good thing because that’s what your brain and body are biologically designed to do in an actual threatening situation. However, for some people the “bear” is always with them, and that fight or flight response is consistently being triggered, changing from a life saving defense mechanism, into a health impairing response.
Illustrated by Adam’s artwork are the many shadow figures, or “monsters” that anxiety can disguise as. The monster can look different for everyone- financial issues, dysfunction in the home setting, crowds, spiders, separation from loved ones, a medical condition, a traumatic event- you name it. Anxiety is not one size fits all, it can be caused by a multitude of factors and experienced differently across all individuals. With that being said,
It is extremely important that we do not dismiss how someone experiences anxiety, because we do not truly know what is going on in someone’s mind and body.
Treatment Options
There are various treatment options used to treat anxiety symptoms/ anxiety disorders. Below I will summarize some possible treatment options, possible medications, as well as food and diet suggestions that could help manage or/and treat anxiety symptoms and disorders.
Cognitive-Behavioral Therapy (CBT)
The most common treatment is Cognitive-Behavioral Therapy (CBT). CBT is a form of psychotherapy (i.e. talk therapy) that helps an individual identify negative behavior and thought patterns. The idea is to help the individual learn problem-solving skills to challenge, reframe ad redirect fears and worries that impair daily functioning. CBT is used widely across a range of mental health conditions. Professionally, CBT is a treatment that I am most familiar with, and used often to treat clients who struggled with anxiety, PTSD, and OCD. Personally, I have been treated with the CBT model, which has helped me manage OCD symptoms.
Dialectical Behavioral Therapy (DBT)
Another type of treatment that can be used to treat anxiety disorders is Dialectical Behavioral Therapy (DBT). DBT is a therapy technique that combines acceptance and mindfulness. It helps individuals develop skills to better regulate, process and accept negative emotions and situations as they are, so that they won’t be in fear/feel powerless to the negative emotions and situations.
Exposure Therapy
When treating phobias, exposure therapy can be beneficial. Exposure therapy helps individuals become desensitized to their phobias through gradually exposing the individual to the feared objects/situations. From personal experience, exposure therapy has helped tremendously in reducing and helping me manage OCD symptoms.
Eye Movement Desensitization and Reprocessing (EMDR)
Similarly, Eye Movement Desensitization and Reprocessing (EMDR), is a therapy technique that helps individuals process disturbing thoughts and information in a less intense, more adaptive manner. EMDR accomplishes this through strategic eye movements, similar to eye movements that occur during the REM (i.e rapid eye movement) sleep cycle. Just as exposure therapy, EMDR has been reportedly effective in treating phobias, as well as panic attacks, PTSD, and OCD.
Anti-anxiety Medications
There are a variety of anti-anxiety medications that are used to treat anxiety disorders; however, the type of medication may be dependent upon the individual and the type of anxiety disorder. Common medications used to treat anxiety disorders include Xanax (alprazolam), Valium (diazepam), Lunesta (eszopiclone), and Klonopin (clonazepam).
Food and Diet Suggestions
In addition to treatments and medications, limiting/eliminating certain foods from your diet while increasing other healthier foods, can reportedly help reduce symptoms of anxiety. Foods that have been found to be helpful include fish, vegetables, fruits, and foods with whole grains and fiber. Foods suggested to limit or eliminate include anything with high amounts of caffeine, refined sugars, additives, gluten (more so if you have a gluten sensitivity), and alcohol.
For Your Consideration
The treatment options and diet suggestions listed above are only a selection of possible techniques, to treat and reduce anxiety symptoms. Each individual is wired differently, and therefore what works for one person may not work for another. It is not guaranteed that these options will work for each individual. For this reason, if you are interested in any of the treatments, medications, or diet suggestions above, I highly recommend that you do further research on it, as well as work with a qualified mental health or/ and medical professional, to develop a plan that will best meet your needs.
Coping Strategies
Although treatments, healthy diets, and medication each have their benefits, it is also important to have some practical coping strategies in your back pocket, for day to day use. Some common coping strategies most clinician recommend include cognitive reframing, deep breathing exercises, muscle relaxation, and other mindfulness techniques. Additionally, an uncommon strategy, but a personal favorite of mine, is ASMR.
Cognitive Reframing
Cognitive reframing is a technique often used and taught within therapy. Essentially, it is a way to redirect negative thoughts, by either challenging if the thought is realistic, true, or beneficial, or by replacing it with a positive thought.
Deep Breathing Exercises
As I mentioned in my previous blog post, Lose Control, practicing deep breathing is extremely beneficial. Deep breathing slows your heart rate down, reduces stress, lowers your blood pressure, and can improve sleep. The reason is because deep breathing causes the brain to release endorphins, which naturally provides a calming/ rejuvenating effect. The key is to actively slow your breathing down by taking a deep inhale, holding for a few moments; then slowly exhaling. Repeat as many times as you would like :).
Muscle Relaxation
Muscle relaxation is another wonderful and recommended technique. The idea is that you redirect your focus from stresses and worries, to a focus on your body. Slowly, focus on one body part at a time, gradually tighten that body part and hold for a few moments, and then release it. Continue to do this until you have reached every part of your body. You can practice this technique lying down or sitting up, and can choose to begin from the top of your body to the bottom, or vice versa. I recommend getting comfortable and lying down while practicing muscle relaxation :).
Other Mindfulness Techniques
Other mindfulness techniques include reorienting yourself with the present, which is a fancy way to say focus on your immediate environment. For example, I am currently up late working on this blog post lol so if I am beginning to feel anxiety about trying finish this within a reasonable time frame, I may try to reduce those feelings of anxiety by refocusing on the things right in front of me- the sound of the sink water running upstairs as my husband kindly finishes up dishes; the color of my keyboard; the light humming of the dryer running in the background. This is a technique that can alleviate stress and anxiety by grounding yourself in the present moment. I personally practice this technique often!
Alongside yoga, guided meditations or guided imagery are other beneficial mindfulness techniques; you can find an array of these on YouTube, or by downloading free or low cost mindfulness Apps in your phone’s App stores.
Autonomous Sensory Meridian Response (ASMR)
As I mentioned above, an uncommon relaxation strategy I personally enjoy is called Autonomous Sensory Meridian Response, also known as ASMR. ASMR is that tingly sensation you typically experience on your scalp or along your back and spine, typically caused by a specific experience or stimuli. Most common sources of ASMR are delicate movements of the hands (e.g. when someone plays with your hair), whispering, clicking/tapping (typically of a keyboard), or page turning/paper tearing. Much like other mindfulness techniques, ASMR can help individuals redirect their focus from stresses and anxiety, to relaxing in the present moment. ASMR has been known to help people relax into sleep- I can personally attest to this! If you search ASMR on YouTube, you will find a plethora of videos.
Faith, Science and Coping
There are various articles and studies that show how anxiety affects the brain and body, as well as treatments and practical coping strategies to manage symptoms of anxiety. However, there are also articles and studies suggesting that an individual’s belief in God can help them cope with anxiety, as well as other mental health conditions. It is suggested that faith that advocates for compassion, forgiveness, and trust in God’s plan, helps the brain build patterns of positive thinking, which minimizes stress hormones and anxiety. These beliefs can help individuals make meaning and purpose out of negative circumstances in life.
On the flip side, however, I do understand how religious beliefs can contribute to anxiety too, especially if they believe that God has abandoned them or is punishing them, loved ones or others. Sometimes this thinking can add to anxiety and stress. I can firsthand attest to this as well. One component of the OCD I experience (which I will discuss further in a future blog all about OCD, stay tuned) has to do with religious obsessions; these obsessions typically have to do with fear that God is going to condemn me. However although it is difficult, I am able to distinguish between an OCD led thought vs. what I know to be true from my experiential knowledge of God, and with what lines up in the Bible. Therefore, I am still able to turn to God and Jesus for support and alleviation of anxiety symptoms that stem from my OCD.
There is a difference between religiosity/legalism, vs. theology and faith. I believe in Jesus. Jesus said the following:
“do not worry about your life, what you will eat or drink; or about your body, what you will wear… look at the birds of the air; they do not sow or reap or stow away in barns, and yet your Heavenly Father feeds them. Are you not much more valuable than they? Can any one of you by worrying add a single hour to your life?” – Matthew 6:25-27
There are examples throughout the Bible of people experiencing hardship- persecution, oppression, captivity, to name a few. Jesus wasn’t immune to this hardship either, because he wanted to show people that he understood what we go through in this world. However, time and time again God showed his care for his people, by providing them with what they needed. With that being said, I understand that there’s a lot of hardships in each of our lives and in the world. Although God may not swoop in to take away every concern, every evil, every anxiety in the world, I do believe that he is not the cause of these hardships.
I do believe, have experienced, and have witnessed, that God does care for us and wants to be the answer to our needs. I also believe that he has called each of us to be the answer, by serving others and meeting the needs of our families, friends, communities, and truly, the world.
My friend kindly reminded me of this bible verse- “Cast all your anxiety on him, because he cares for you.” – 1 Peter 5:7
Another reminder that I often have to lean on is this: [Jesus speaking] “I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world.” – John 16:33
When I am struggling under the weight of stress, anxiety, and my struggles with OCD, these verses, along with many others, bring me peace and help me to cope. <3
Conclusion
There are many factors that cause and contribute to anxiety and anxiety disorders. For this reason, anxiety is experienced differently by each individual, and no one should be judged for how they cope with their anxiety. I cannot stress that last sentence enough. I hope this post provided helpful insights, to help each of us be more sympathetic to the needs of others.
Once again, I would like to highlight that I am merely providing information based on my research, professional and personal experiences. I am in no way diagnosing anyone, or indicating that they should receive treatment or/and medication. If you struggle with anxiety, or think that you may have an anxiety disorder, and would like to receive further help, please seek out help from a medical or mental health professional. Please do your own research to better understand and explore all treatment options and available resources. For more resources, please refer to my resource page.
Hang in there- there is help and you are not alone! Please feel free to reach out to me via my contact page with any questions or concerns.
Keep pressing on!
-Amanda
Artwork credit: Adam Sally, Oxford, Michigan. Adam is the creator of the banner image for this blog post. Sketching first in pen and then ultimately finalizing his work through photoshop, Adam created an extremely life like image of me wrestling with the many monsters/shadow figures- or forms of anxiety- that people take on. Through creative collaboration, Adam and I discussed how anxiety can be experienced physically. Through his own creativity, Adam perfectly illustrated this physical experience, by drawing the shadow figures tugging at my neck, chest, and whole body. Adam perfected my original vision into something I couldn’t have dreamt up or created myself! I have so much appreciation and gratitude for my awesome friend, and his obvious talent!
Adam is a man of many trades! Along with his art skills, Adam is talented at graphic design, logo design, social media content creation, real estate videography, wedding/event videography, and video marketing. If you need services that exceptionally represent your visions and businesses, Adam is your guy! Check him out on Facebook and Instagram
References:
Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition- American Psychiatric Association
Evidence That Demands A Verdict: Life-Changing Truth For A Skeptical World- Josh McDowell & Sean McDowell, PhD
Foods That Harm, Foods That Heal- Reader’s Digest
Life Application Study Bible, New International Version (NIV)
Psychopharmacology: Straight Talk on Mental Health Medications- Joe Wiegmann, RPh, LCSW
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