The Two Faces of “Anxious”

NOTE: This post first appeared on lifehack.org, where I am now a columnist.

“Anxious” is a word with two faces. Sometimes it means eager excitement. “I’m anxious to see you!” we say, as we get off the phone with a friend who’s coming to visit. The other side of “anxious” is a bit darker: “I’m anxious about that test,” we say, when we’re worried about the results. We call the second meaning “anxiety,” and most of us experience it from time to time.

In common usage, both meanings of “anxious” describe our responses to fleeting, time-limited events. But anxiety can also have a much more powerful grip on many of us. Without the right kind of attention, it can rule our lives.

I’m a psychotherapist in private practice north of Boston, Massachusetts, and I’ve worked with many clients who have anxiety. In this, the first of two articles on a psychotherapist’s views on anxiety, I’ll describe what anxiety is and how you can tell whether you or someone close to you is suffering from it. In Part II, I’ll go into its causes and treatments, as well as the best ways to help heal from anxiety disorders.

Anxiety is more common than people think

More people in the United States have anxiety disorders than any other mental illness. Anxiety affects more than 40 million adult Americans and about one in eight children. Some experts put the estimate much higher, because many people don’t know they have anxiety, are diagnosed incorrectly, or don’t seek help for it.

In my psychotherapy practice, nearly all my clients have some form of anxiety. Sometimes it’s the main reason they came to therapy, and sometimes it’s an underlying issue that shows up after we’ve handled the immediate reason they came for help.

Only about one-third of people who have anxiety disorders seek treatment.

Many anxious people know they have anxiety, but many more do not. They think catastrophizing, expecting the worst, worrying about what people think of them, or staying up late at night worrying about just about everything is normal.

It feels normal because that’s what they’ve been used to most of their lives – but it doesn’t have to be. Most people with an anxiety disorder can overcome it with treatment, support, and self-help strategies.

The difference between feeling worried and having anxiety

An anxiety disorder is different from feeling worried or being afraid. Worries about new or uncertain situations are normal, and feeling afraid in potentially dangerous situations is not only normal, but can sometimes save your life. Worrying about how you will perform on an exam might motivate you to study harder. Worrying about an erratic driver in front of you might help you drive more defensively. Feeling fearful about driving on a winding road in a storm might get you to wait for safer weather conditions.

Also, not everybody who worries a lot has an anxiety disorder. You might feel anxious because of too much work, too much stress, too little sleep, too much coffee, or low blood sugar.

The biggest distinction between normal worry or fear and anxiety disorders is that anxiety disorders involve some form of chronic anxiety, and the anxiety interferes with normal functioning.

7 specific anxiety disorders

There are several kinds of anxiety disorders, and they each look and feel different from one another. One person might have intense panic, another might avoid social situations, another might be unreasonably frightened by dogs, and someone else might worry about nearly everything.

All anxiety disorders share a persistent fear or worry in situations where most people would not be afraid. Specific anxiety disorders have other, specific symptoms.

1. Social Phobia

People with social phobias are afraid of embarrassment or judgement in social situations and may blush, feel tongue-tied, go blank, have rapid heart rate, or show other signs of anxiety in those situations. They will avoid social situations whenever possible.

2. Special Phobias

People with special phobias might be unreasonably afraid of animals such as dogs or spiders, natural events like storms or lightning, heights, open spaces, enclosed spaces, and other parts of the normal world. They may go to extremes to avoid these things.

3. Generalized Anxiety Disorder

Symptoms of Generalized Anxiety Disorder (GAD) can include feeling nervous most of the time, a sense of impending doom, feeling helpless, rapid breathing, increased heart rate, sweating, trembling, a queasy feeling, and tension in the neck, shoulders, or both.

4. Acute Stress Disorder and Post-Traumatic Stress Disorder (PTSD)

Both of these anxiety disorders sometimes occur after people have witnessed or experienced a physical threat. Symptoms include disturbing memories, flashbacks of the event, trouble sleeping or concentrating, and feeling either tense or numb. Acute Stress Disorder symptoms begin within a month of the traumatic event, while PTSD symptoms typically begin later. Symptoms can last for many years without treatment.

5. Panic Disorder

People with panic disorder have unexpected, severe anxiety attacks during which they are afraid they might die, pass out, or that they are suffocating. They often avoid places where panic attacks occur, which can lead to agoraphobia.

6. Hypochondria

People with hypochondria (now called Illness Anxiety Disorder) worry about having illnesses they probably don’t have. They catastrophize minor or imagined symptoms into a worst-case scenario. For example, they may be convinced that a headache means they have a fatal brain tumor.

7. Obsessive-Compulsive Disorder (OCD)

Sufferers may check obsessively, count when counting is unnecessary, and in general do ritualized behaviors. They feel unbearably anxious if they do not perform these rituals.

The most common anxiety disorders, in approximately this order, are: Social Phobia, Specific Phobias, Generalized Anxiety Disorder, Acute and Post-Traumatic Stress Disorders, Panic Disorder, Hypochondria, and Obsessive-Compulsive Disorder

In my practice, I most often encounter Generalized Anxiety Disorder and PTSD, though I have also had many clients with Panic Disorder, Hypochondria, Social Anxiety Disorder, and Obsessive-Compulsive Disorder. Sometimes, people come in with more than one anxiety disorder. Hypochondria and Generalized Anxiety Disorder, for example, often show up in the same person, as do Social Anxiety Disorder and perfectionism which, though not an “official” anxiety disorder, contributes greatly to most forms of anxiety.

Signs of anxiety disorders

If you identify with any of the following symptoms, you might be dealing with an anxiety disorder.

• You’re almost always worried or on edge.
• You have irrational fears that you just can’t shake.
• You’re often afraid that bad things will happen if you don’t do things in a particular way.
• You avoid everyday situations or activities because they make you anxious.
• You have sudden, unpredictable attacks of heart-pounding panic.
• You almost always expect the worst.
• You have trouble getting to sleep or staying asleep.
• Your muscles almost always feel tense.
• You often feel overwhelmed.
• You expect more from yourself than most people do
• You tend to focus on your health and personal problems more than other things in your life.
• Your anxiety interferes with work, school, or family life.
• You have one or more of the following physical symptoms: pounding heart, sweating when you’re not exercising or in a warm place, headaches, frequent upset stomach or diarrhea, dizziness, shortness of breath, shaking or trembling.

Some anxiety disorders are harder to spot

In my experience with psychotherapy clients, PTSD is usually the most difficult to spot because its symptoms don’t always cleanly match the standard definition. PTSD can look like depression, several other forms of anxiety disorder, ADHD, or a combination of mental illnesses.

An example: I once worked with a client who seemed to cycle through several anxiety disorders within a few months. She first displayed typical signs of panic disorder, and we quickly worked through them. But then OCD symptoms appeared. Again, we worked through them in what seemed like record time. Irrational fears and intrusive, disturbing thoughts soon followed.

It was a few months before we understood that what she was actually suffering from was the aftermath of childhood trauma. She had what I now think of as free-floating anxiety – a form of anxiety that unconsciously attaches itself to other anxiety syndromes. A clue to understanding how to help her was that she had majored in psychology and knew about various mental illnesses. Her half-remembered knowledge of common anxiety disorders gave her free-floating anxiety a place to focus. Working through the trauma helped her resolve all her anxiety symptoms.

Stay tuned!

In this article, we’ve looked at how worrying and fear are different from anxiety disorders and have identified the main symptoms of common anxiety disorders. In Part II of this two-part series, we’ll go into the causes of anxiety disorders, their treatments, and some self-help practices people with anxiety disorders and their loved ones can do.

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