Anxiety is a normal response to stress or danger, but it can be debilitating. At times it is helpful because it can help prepare the body for action, and it can improve performance in a range of situations. Anxiety becomes a problem when it is experienced intensely and it persistently interferes with a person's daily life.
Depression and anxiety commonly occur together. Not everybody who is anxious is depressed, but most depressed patients have some symptoms of anxiety. (It is thought that depression follows on as a response to anxiety such that anxiety is suppressed to such an extent that it is no longer experiences. Anxiety may reoccur as the depression lifts.)
Aren't some people just anxious all of the time?
People have different degrees of background, or 'trait', anxiety. High trait anxiety may stem from inherited behaviour or early relationships in childhood. It is also related to personality.
In addition to this inherent background anxiety, people react differently to everyday situations. Some people become anxious very easily, others never seem to get anxious. The anxiety that people get because of specific experiences is called 'state' anxiety.
An individual with high trait anxiety is particularly vulnerable to experiencing high state anxiety in stressful situations.
How common are symptoms of anxiety?
Anxiety symptoms are extremely common - everybody experiences them from time to time. Specific anxiety disorders or illnesses are also not as rare as you might think, being present in around 5 per cent of the population at any time.
What are symptoms of anxiety?
Anxiety can be experienced in a number of different ways.
- Inner tension.
- Fear of losing control.
- Dread that something catastrophic is going to happen, such as a blackout, seizure, heart attack or death.
- Feelings of detachment, as if being trapped in a bubble separate from the world.
- Racing heart beat (palpitations).
- Breathing fast, feeling short of breath or finding it hard to 'get breath'.
- Chest tightness.
- Dry mouth, butterflies in the stomach, feeling sick.
- An urge to pass urine.
Hyperventilation (overbreathing) syndrome AKA Panic Attacks
This is a particular combination of symptoms that affects some people. Both patients and doctors can often mistake it for serious medical illnesses, including epilepsy and heart attacks.
An episode of hyperventilation starts when a person begins to breathe rapidly and shallowly. This may be triggered by something obvious that leads to anxiety, but often there is no obvious cause for the change in breathing.
Breathing rapidly and shallowly causes changes to the chemistry of the body, which in turn lead to physical symptoms such as tingling in the fingers and around the mouth (paraesthesia), and light-headedness (and sometimes fainting). This pattern of breathing - without fully breathing out - leads to a feeling of chest tightness.
These symptoms are not medically dangerous as such, but they tend to be frightening, and this in turn causes an increase in anxiety and the development of a vicious circle.
Hyperventilation can be simply treated by breathing in and out of a paper (not polythene) bag for a short time, which reverses the chemical changes caused by overbreathing. However, in the longer term it is best dealt with by treating the underlying cause of the anxiety and learning how to relax.
What types of anxiety disorders are there?
There are a number of 'types' of anxiety disorders. They tend to overlap considerably and it is not uncommon for people to have features of several of the disorders.
Generalised anxiety disorder
Generalised anxiety disorder (GAD) is characterised by anxiety symptoms that are present for much of the time and not restricted to specific situations.
Generalised anxiety often accompanies phobias and is extremely common in people who are depressed. It can also be caused by physical illness, such as an overactive thyroid gland, or result from the emotional response to a serious illness such as a heart attack.
Some 15 per cent of people with GAD have a brother, sister or parent with a similar problem. This may reflect an inherited tendency to the disorder or the effects of the family environment. Two thirds of sufferers are women.
In panic disorder, repeated panic attacks occur unpredictably and often without obvious causes. The attacks consist of severe anxiety with physical and psychological symptoms.
Physical symptoms can include any of the general symptoms of anxiety described above and typically the hyperventilation syndrome mentioned above.
Psychological symptoms typically include dread (particularly of extreme events such as dying), having a seizure, losing control or 'going mad'.
To the sufferer, the attacks feel as if they are going on for a long time, but actually they tend to last only a few minutes, and at their longest they last around an hour. Panic disorder is common in depression, GAD or agoraphobia.
A phobia is a fear that is out of proportion to the situation that causes it and cannot be explained away. The person typically avoids the feared situation, since this helps to reduce the anxiety.
Some phobias represent heightened normal anxiety towards situations that people are evolutionarily 'prepared' to fear, eg snakes, heights and sharp objects.
In other instances, a phobia may arise by a non-threatening situation being associated with a traumatic experience. Having a car crash in Spain may lead to a phobia of Spain itself, holidays, driving or flying.
Phobias typically occur in specific situations, eg a fear of dentists. People experience 'anticipatory anxiety' when thinking of the situation and so attempt to avoid it. They are common in the general population, but are only severe enough to prove disabling in 2 per cent of people.
Phobias are often the result of a "one time learning" process whereby a single experience is processed into a phobic response very, very quickly. This tendancy is increased if the person is stressed / anxious at the time or if the persons neurones are being over stimulated by the effects / after effects of recreational drugs.
Simple phobias are phobias that are specific to objects or situations. Specific phobias include:
- animal phobias (eg dogs, snakes, spiders): the start of these phobias is often in childhood, usually before the age of seven years.
- blood and injury phobias: the fear of blood tests or the sight of blood that results in fainting.
- vertigo: a fear of heights.
- agoraphobia: an intense fear of leaving the home, being in crowded spaces, travelling on public transport and being in any place that is difficult to leave. Around 75 per cent of sufferers are women, and it occurs in just under 1 per cent of people. Agoraphobia may follow a life event and be associated with a fear of 'what if it comes back while I am away from home'. It commonly occurs with panic attacks. The person may have a panic attack when outside the home and this reinforces the belief that it is safer to stay inside. Agoraphobia is often associated with depression.
- social phobia: a fear of social interaction with others, talking to people, eating, drinking and speaking in public. In contrast to agoraphobia, men and women are affected equally. Many people have a mixture of both agoraphobia and social phobia. Social phobia is also a common symptom of depression. More about social phobia and hypnotherapy / EMDR / NLP...
Click here for more information relating to phobias
Obsessive-compulsive disorder (OCD) is a the forth most common psychiatric disorder. While many people (14 per cent of the general population) have minor obsessional symptoms, formally diagnosed OCD itself occurs in about 2%  of the population. ( Obsessive-Compulsive Disorder, Maj/Sartorius/Okasha/Zohar, Wiley 2000). Men and women are equally affected. It frequently comes on in adolescence, but often people do not go to their GP for help for many years.
An increase in obsessional symptoms can occur in depression. The symptoms for this anxiety disorder include:
- obsessional thoughts that come repeatedly into the person's mind, despite him or her trying to stop them. They are unpleasant and often abhorrent. The thoughts are clearly recognised by the person as being their own. Trying to stop the thoughts causes other anxiety symptoms.
- obsessional thoughts may include a fear of dirt or germs, doubting that something important has been done (such as locking the door, turning the lights off) or unpleasant and graphic images in the mind of harming others or themselves. People who are suffering from OCD tend not to carry out any of the unpleasant thoughts they are having, though they usually fear they will.
- compulsive acts (obsessional acts) are repetitive actions based on the obsessional thoughts - a person with obsessional thoughts about dirt may spend long periods cleaning the house and washing their hands (these actions are not pleasurable, but they help to reduce the anxiety associated with the obsessional thoughts).
- the compulsive actions often have a 'magical quality', eg a person must check the door is locked exactly seven times, no more or less. If they are unsure how many times they have checked, they may start all over again. In severe cases, sufferers may spend many hours of the day undertaking these acts so that they have no time for anything else.
Evidence from brain scan studies shows altered brain function in people with OCD - some parts of the brain are underactive, others overactive. Inherited factors can play a role in the development of the disorder, but otherwise we have few ideas about what are the biological or psychological causes of OCD.
There are a number of psychological consequences to major stressful events and these often include symptoms of anxiety. There are three types of reactions:
- acute stress reaction starts within minutes (if not immediately) of the stressful event. It also tends to resolve rapidly, once the person is able to get out of the stressful situation. Symptoms are mixed, with the person first appearing dazed and disorientated. In addition, other symptoms of anxiety, anger and withdrawal can occur.
- adjustment reaction starts within one month of the stressful event, and symptoms tend to resolve within six months. They may include depression, anxiety, irritability and a feeling of being unable to cope. Grief for the loss of a loved one can be seen as a combination of an acute stress reaction in the early stages, followed by an adjustment reaction.
- post-traumatic stress disorder (PTSD) tends to come on weeks, or even months, after a stressful event that was of an exceptionally threatening or catastrophic nature, which would cause distress in almost anyone. It can persist for years. Symptoms include flashbacks (vivid memories of the event), nightmares, avoiding anything associated with the stressful event and being on edge. In addition, sufferers often experience generalised anxiety, panic disorder, depression, guilt (of surviving) and blunting of their emotions. PTSD is generally treated using hypnotherapy and EMDR
Diagnostic and statistical manual criteria (DSM)
Research: David Spiegel in the Harvard Mental Health Letter
In a report by David Spiegel in the Harvard Mental Health Letter, the research was cited that Hypnosis methods have been used successfully for anxiety associated with medical procedures.
Two hundred forty-one patients who were undergoing percutaneous vascular and renal procedures were randomly tested on three testing regimens, one of which was Hypnosis. Patients rated their pain and anxiety on 1-10 scales before, every 15 minutes during, and after the procedures. Pain remained flat over the duration of procedure time in the Hypnosis group; pain increased linearly with procedure time in both other groups. Anxiety decreased over time in all three groups; the sharpest decrease was in the group that was hypnotized. Procedure times were significantly shorter in the Hypnosis group. In addition, Hypnosis showed itself to be superior in improving hemodynamic stability. ... (Source: www.counselorsassociated.com)
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