Anxiety Disorders: When to Worry about Anxiety

By Dr. Alex Dimitriu, 12/13/18

We all worry. Occasional anxiety is part of everyday life –- an upcoming test, a job interview, a troubled relationship –- and anxiety may have a beneficial effect, helping us focus and problem-solve by studying for the test, preparing for the interview, or working on the relationship. But for millions of people, anxiety is excessive, disproportionate to the situation, generalized, and impossible to alleviate or control. Anxiety disorders are the most prevalent mental disorders and take an enormous toll.

Anxiety can be thought of on a spectrum. At the low end, is what we think of as normal, temporary, anxiety that does not interfere with daily functioning. At the other end are clinical, diagnosable levels at which anxiety is severe, constant, and disruptive to work, school, and relationships. This kind of anxiety is not a character flaw but a treatable condition. And it’s important for people who may think of themselves as ‘worriers’ to recognize when they need help to deal with the severity of their anxiety.

There is a wide variety of anxiety disorders that differ by the situations that induce them but have in common a level of excessive anxiety and resulting behavioral disturbance. Among the more common are generalized anxiety disorder, panic disorder, and various phobia-related disorders.

Generalized anxiety disorder (GAD) is characterized by excessive anxiety focused on any number of things such as health, finances, work, school, safety, and other normal life circumstances. People suffering from GAD feel restless, on edge, and locked in to daily, uncontrollable worry. They may have difficulty sleeping and physical symptoms such as muscle tension and digestive problem.

Panic disorder causes recurrent, sudden panic attacks – the onset of intense fear that escalates quickly. The attacks may be triggered by a specific situation or occur unexpectedly without an apparent trigger. Sufferers have a feeling of impending doom, loss of control, and symptoms that include heart palpitations, shortness of breath, sweating, and trembling. Additional anxiety is caused by the fear of an attack and attempts to avoid situations that might induce one.

Phobia-related disorders: A phobia is an intense fear of a specific object or situation, out of proportion to any actual danger. People with a phobia experience irrational anxiety about encountering the feared object or situation and may employ extreme avoidance measures. Examples of specific phobias include heights, flying, blood, and animals such as spiders or snakes. Social anxiety disorder is intense fear in social or performance situations, generally focused on fear of poor performance and embarrassment. Agoraphobia may be fear of either open spaces, enclosed spaces, or crowds; in extreme cases, individuals become housebound.

Both genetic and environmental factors contribute to the risk of developing an anxiety disorder. A family history of anxiety or other mental disorders may be a factor, as well as exposure to stressful or negative events, particularly in childhood. Whatever the cause, treatment of an anxiety disorder is tailored to the individual’s specific situation and may involve medication or psychotherapy or both.

Cognitive behavioral therapy, which helps people learn different ways of thinking and acting when exposed to anxiety-inducing situations, has been particularly effective in treating anxiety disorders as has exposure therapy, which focuses on confronting the fear that underlies the anxiety. Medications such as anti-anxiety drugs and antidepressants cannot cure anxiety disorders but can relieve their symptoms.

Here’s tips for differentiating every-day worry from clinical anxiety:

• Worry is more often based on realistic concerns that can be managed and resolved; anxiety is less rational and less controllable.
• Worry can be a beneficial stimulus to address a problem; anxiety is diffuse and resists solutions.
• Worry is temporary; anxiety is on-going and may shift to a new focus.
• Worry doesn’t affect daily functioning; anxiety may disrupt work, school, and other activities.
• Anxiety is more likely to produce physical symptoms.
• Persistent worrying about worrying may be an indication of anxiety.
• Consistently anticipating the worst possible outcome in every situation may indicate anxiety.

A diagnosis of an anxiety disorder and the need for treatment must be made by a medical professional, but there are also self-help steps you can take to manage anxiety. Healthy diet and exercise habits, stress management and relaxation techniques, and meditation can support and enhance the benefits of therapy and improve one’s sense of self and control.

Alex Dimitriu, MD, is founder of Menlo Park Psychiatry & Sleep Medicine in Menlo Park, CA. He is dual board-certified in psychiatry and sleep medicine.