Anxiety in a Nutshell

Difference Between Anxiety and Stress

Anxiety and stress are related experiences, but they are different in terms of their causes and symptoms.

Stress is a normal physiological response to external triggers and challenges and can be beneficial when appropriate. The Yerkes-Dodson law suggests that people perform best when having intermediate-level stress. Various issues, such as work, relationships, or financial problems, can cause stress.

On the other hand, anxiety is a feeling of worry, nervousness, or fear that is persistent and often out of proportion to the situation. Anxiety is often a stress response and can become a disorder when it affects daily functioning.

In summary, stress is a normal response to a challenging situation, while anxiety is a prolonged and intense feeling of fear or worry that may interfere with daily activities.

Difference Between Anxiety Disorders and Anxiety

Anxiety disorders are very common mental disorders. They are not the same as normal anxiety, worry or fear, which are normal human emotions if they have stress. When people feel anxious, worried and fearful under stress, it does not mean they have anxiety disorders. Normal anxiety, worry or fear usually does not last too long, has limited interference with life and work, and the degree of those emotions is not too severe. However, the symptoms and impact of anxiety disorders are more severe.

Symptoms of Anxiety Disorders

Physical symptoms

1. Heart racing: feeling that your heart is beating fast or pounding.
2. Sweating: feeling sweaty on the palms, feet, or all over the body.
3. Chest pain and shortness of breath: unable to catch breath, and a feeling of tightness in the chest.
4. Fatigue: feeling physically worn out.
5. Choking: feeling like something is stuck in your throat or your throat feels tight.
6. Headache: pain in any region of the head.
7. Upset stomach: stomach pain, nausea, vomiting, or diarrhea.
8. Chills and shaking: chilling, shaking, or trembling of hands and feet.
9. Hot flushes: feeling that the whole body is hot or that one part is hot but not sweating.
10. Dizziness: feeling dizzy and light-headed.
11. Loss of control: when symptoms are severe, there may be a feeling of loss of control and a sense that you may be dying.
12. Sleep problems: Difficulty falling asleep, waking up early, easy to wake up during sleep.

Most of the above symptoms are also commonly seen in panic attacks. When a person experiences a panic attack, the above symptoms will become severe in a short period of time. People with anxiety disorders or normal anxiety and fear can also have the above symptoms, but to a lesser extent than panic attacks. Also, not everyone experiences all of the above symptoms when they are anxious or have anxiety disorders.

Emotional symptoms

1. Worry: intense anxiety or worry about the future or life events.
2. Nervousness: feeling tense, restless, or anxious.
3. Fear: feeling afraid of certain circumstances or situations.
4. Irritability: being irritable or impatient.
5. Depression: feeling down, frustrated and disappointed.
6. Guilt: feeling guilty or self-blaming.

Cognitive symptoms

1. Excessive worry: excessive worry and fear about life events.
2. Inattention: has difficulty concentrating.
3. Catastrophic thinking: tend to think about the worst-case scenario in everything.
4. Self-doubt: thinking you can’t handle the worst-case scenario if it happened.
5. Overthinking: an excessive preoccupation with stressful events.
6. Obsessive thoughts: repetitive, unrealistic, or meaningless thoughts that are difficult to stop.

Behavioural symptoms

People usually engage in the following two types of behaviours to reduce their anxiety:

1. Over-compensation: excessively doing things like double-checking work to make sure nothing goes wrong; working late into the night for upcoming exams/deadlines; talking too much intentionally to not appear awkward in social situations.
2. Procrastination or avoidance: procrastinating or avoiding doing something, such as finishing a task until the last second, because the process of doing the task makes people anxious, so they don’t want to feel it; avoid dealing with people as much as possible, because they feel uncomfortable in social situations.

The above symptoms will interact with each other. For example, when people feel more anxious, they are more likely to think negatively and experience physical sensations such as heart racing, chest pain, shortness of breath, chills or hot flushes. As a result, they tend to overcompensate or procrastinate to reduce their anxiety.

It is worth noting that anxiety symptoms and depressive symptoms often occur together; please click here for an introduction to depression.

Common Types of Anxiety Disorders

Generalized Anxiety Disorder (GAD): it is chronic anxiety, manifested as excessive worry about trivial things in life, and usually, the level of worry does not match the actual severity of the problems faced. Even when life is going well, there is constantly thinking about the possibility that things could go wrong. At its core, people with GAD has challenges handling uncertainty. The symptoms usually last for months and interfere with daily life.

Panic Disorder: it is a mental disorder caused by excessive fear of panic attacks. The symptoms of panic attacks are mentioned above. It is a sudden and intense fear response, usually accompanied by physical symptoms such as heart racing, shortness of breath, sweating, nausea, and vomiting. This symptom usually occurs without an obvious trigger. Panic attacks are very common, but if you avoid any situation that may cause a panic attack due to excessive fear, you may develop panic disorder.

Social Anxiety Disorder: it refers to the strong fear of social situations, also known as social phobia. Such fears in social situations include fear of being judged, criticized or rejected, making a mistake or looking awkward, etc. The symptoms often cause people to avoid social situations or feel very distressful in social situations.

Phobias: they include Agoraphobia and Specific Phobias. Agoraphobia is a mental disorder characterized by an intense fear of open spaces or crowded places. It includes fears of being trapped or unable to escape and worries about being nervous in public or having a panic attack that would lead to embarrassment or having no one to help. Agoraphobia may cause people to avoid open spaces and crowded places, or feel very distressful when in these places. Specific phobia is a mental disorder involving intense fear of a particular object or situation. Specific phobias can be of various types, such as fear of animals (e.g., dogs, spiders, etc.), fear of physical environments (e.g., heights, bridges, etc.), and fear of medical procedures (e.g., injections, blood draws, etc.). Specific phobias may result in avoidance of the feared object or situation or feeling very distressful when facing the feared object or in the feared situation.

Illness Anxiety Disorder: it is also known as health anxiety or hypochondriasis. It refers to excessive worry and fears about physical health. This worry does not match reality and affects the quality of life. It often results in excessive focus on unusual physical sensations or discomfort, feeling like you have some undiagnosed disease, and constantly researching medical information and visiting doctors. It can also sometimes lead to panic attacks. Although illness anxiety disorder is not classified under the category of anxiety disorders in the diagnostic manual, its symptoms are similar to anxiety disorders.

Obsessive-Compulsive Disorder (OCD): people with OCD usually have repetitive and intrusive thoughts that are meaningless and against their wills (“obsessive thoughts”), such as the stove is not turned off, the door is not locked, and their hands are dirty. The obsessive thoughts are annoying and anxious. To reduce their anxiety, people usually start repeating some behaviours (“compulsive behaviours”), such as repeatedly checking the stove, returning to the door after leaving home, and frequently washing hands. When suffering from OCD, people feel very distressed and fight hard against the thoughts and behaviours but cannot push it away. Although it is not classified under the category of anxiety disorders in the diagnostic manual, its symptoms are very close to those of anxiety disorders.

Unspecified Anxiety Disorder: it refers to that the content of people’s anxiety does not belong to any of the anxiety disorders mentioned earlier, but the anxiety level is high, the duration is long, and the interference with life and work is significant.

Note: anxious symptoms vary for each person, and you don’t need to have all the above symptoms to meet the diagnostic criteria. Do not self-diagnose based on the symptoms above or an online anxiety quiz. If you suspect you are suffering from anxiety disorders, please seek professional assessment and treatment from mental health professionals, such as registered psychologists, family doctors, and psychiatrists. 

Causes of Anxiety Disorders

Like other mental disorders, such as depression, anxiety disorders are caused by a combination of environmental, biological, psychological, and behavioural factors.

Environmental factors:

1. Negative life events, such as the loss of a loved one, traumatic events (such as being abused, raped, accidents, etc.), losing a job or not doing well at work, family conflicts, relationship tensions, etc.
2. Interpersonal factors such as loneliness, interpersonal conflict, social pressure, etc.
3. Work environment, such as long-term high-pressure work, job burnout, toxic work environment, job frustration, etc.
4. Environmental pollution, such as noise pollution.
5. Chronic poverty or financial hardship.
6. Unfair social environment, such as gender/race/class discrimination, political corruption, etc.
7. Childhood trauma, also known as Adverse Childhood Experiences (ACE), includes emotional neglect, physical or psychological abuse, domestic violence, parental divorce or separation, family members suffering from mental disorders, etc.

Physiological factors:

1. Traumatic Brain Injury: An injury to some crucial parts of the brain caused by an external force.
2. Hormonal changes: Hormonal changes, such as those caused by pregnancy, menopause, or thyroid disease.
3. Heredity: If a family member suffers from anxiety disorder, the next generation has a higher risk of developing it.
4. Chronic illness: Chronic illnesses such as chronic pain, heart disease, respiratory disease, Irritable Bowel Syndrome (IBS), or cancer can increase the risk of anxiety disorders.
5. Long-term sleep problems: Long-term sleep disturbances or insomnia can increase the risk of anxiety disorders.
6. Substance abuse: People with alcohol, drug or caffeine abuse also have an increased risk of anxiety disorders.
7. Nutrition: A healthy and regular diet plays a significant role in mood, many years of scientific research showed a strong connection between gut microbiome and brain/mental health . Excessive intake of inflammatory foods (e.g., fried food, fatty food, processed food) and high-sugar foods may lead to anxiety. Eating more fermented foods, high-fibre foods, and foods rich in magnesium and zinc can help relieve anxiety.

Psychological factors:

1. Thinking styles, including but not limited to (a) selectively focusing on the negative side of things and ignoring the rest of the picture; (b) jumping to conclusion, assuming that the information you know must be accurate and comprehensive, so you can quickly conclude; (c) catastrophic thinking, thinking that things will go so badly that you are completely unable to cope; ( d ) all-or-nothing, if one thing is not white, it must be black; (e) perfectionism, if one thing If you can’t do your best, you’d rather not start. Generally speaking, anxious people tend to overestimate the problems and underestimate their coping abilities.
2. Self-criticism, you hold very high standards and expectations for yourself; as long as you fail to meet the standards in your mind, you will criticize yourself and think that you are not good enough.
3. Repressing emotions, you think that you should not have any negative emotions, so once there are negative emotions, you will suppress them in every possible way. It often results in hypersensitivity to emotions or becoming emotionally numb.
4. Avoiding all uncomfortable feelings, you avoid everything that makes you feel uncomfortable; it will gradually lead to life becoming more and more limited, and, thus, more anxious.
5. A sense of meaninglessness in life, such as feeling confused about one’s own life, work, interpersonal relationship, family relationship, and intimate relationship, thinking that there is no sense of meaning, but you are unable to change, and thus starting to be anxious.

Behavioural factors:

1. Lack of exercise can lead to an increased risk of anxiety disorders.
2. Lack of outdoor activities and staying indoors for a long time are not conducive to a good mood.
3. Inadequate problem-solving or communication skills, if you can’t cope with various life difficulties or interpersonal conflicts, you will be more likely to be frustrated, which can lead to anxiety disorders.
4. Avoidance, under the influence of avoidance tendency, people intentionally or unintentionally avoid all things that may make them feel anxious. This type of behaviour can help in the short term, but in the long run, it can worsen anxiety.
5. Overcompensation has very similar effects to avoidance. Overcompensation improves anxiety in the short term but makes anxiety persist longer in the long term.

Treatments for Anxiety Disorders

Because the causes of anxiety disorders are very complex, the treatments of anxiety disorders also require a diverse approach, specifically including the following types of treatment:

Drug Treatments

Commonly used medications for anxiety disorders include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), antipsychotics, benzodiazepines and anxiolytics, etc. However, it’s worth noting that not all people with anxiety disorders need medication, and every drug has some adverse reaction and dependency. Therefore, people with anxiety need to communicate closely with their family doctors or psychiatrists regarding questions like “do I need to take medication”, “what medications to take” and “what are the adverse reaction and withdrawal symptoms of the medication”.  

Psychotherapy

A large number of studies have shown that many psychotherapy approaches have a very good effect on anxiety disorders, such as Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Emotion-focused Therapy (EFT), Exposure and Response Prevention (ERP), etc. However, each approach has its uniqueness, and many professionals combine multiple approaches simultaneously. Therefore, finding the right professional for you and a treatment you like is very important.

Social Intervention

Actively improving one’s living environment is very helpful in improving anxiety disorders. The living environment includes the natural environment and the social environment. Therefore, establishing healthy interpersonal and intimate relationships, doing jobs that are suitable and you are good at, choosing a workplace with a healthy culture, improving financial conditions and getting more in touch with nature are all good for improving anxiety disorders. 

Click here to have a 10-minute free phone consultation with Dr. Houyuan Luo, a registered counselling/clinical psychologist in Toronto, Ontario.