Anxiety: A complete guide to understanding this emotion

Sweaty palms, nerves, and panic attacks are what over 40 million Americans deal with. What is anxiety and how is it measured? What are the different types? How does it tie into depression and what are the symptoms, causes, risk factors, and treatments? How does it affect the body and how does it affect the brain? What are some tips to better deal with it?

Anxiety

What is anxiety?

Anxiety is defined by the American Psychological Association (APA) as “an emotion characterized by feelings of tension, worried thoughts, and physical changes.” Anxiety overall is a generalized term for various disorders that cause worry, fear, apprehension, and nervousness. These various disorders range from mild to severe and can be unsettling and affect day-to-day living. They affect how we behave and how we feel… sometimes to the point that it causes physical symptoms.

Anxiety stems from our need to survive- also known as fight-or-flight mode. This is because back in the early days of humans, incoming predators and danger set off the alarm bells in our brain and our bodies rushed with adrenaline and they began to sweat, with increased heartbeat and sensitivity to one’s surroundings. Considering that most people don’t need to watch for incoming predators and imminent danger anymore, our modern state of being anxious stems from money, work, health, and family life among other things.

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Within the United States, 40 million people are estimated to be affected by anxiety disorders. While it is considered to be the most common group of mental illness in the country, only 36.9% of people with it get treatment.

Anxiety can be measured using questionnaires, such as the Clinically Useful Anxiety Outcome Scale. Another measurement option is to use scales, such as this one.

Types of anxiety disorders

An anxiety disorder is when a reaction is out of proportion to what someone would normally expect. It involves recurring concerns and intrusive thoughts. There are seven types:

• Generalized anxiety disorder (GAD) is the most common anxiety disorder. It’s a chronic disorder that includes long-lasting, excessive worry about nonspecific life situations, events, and objects.
• A phobia is an irrational fear of a certain object or situation. Phobias are different from other fearing disorders because it relates to something in specific. Typically, the fear is irrational, but the person who feels the phobia doesn’t really have control over it.
• Panic disorder is a sudden or brief attack of intense terror. These attacks occur and escalate quickly. They tend to peak after 10 minutes, but they may last for hours. They can cause confusion, nausea, dizziness, shaking, and difficulty breathing. A gene was recently found that shows susceptibility to panic disorders.
• Separation anxiety disorder is known for its high levels of uneasiness when separated from someone or someplace that provides comfort, security, or safety. It can lead to panic disorder if severe enough.
• Obsessive-compulsive disorder (OCD) is known for repetitive, disturbing, and intrusive thoughts and actions. People who suffer from OCD usually are aware that their compulsions are irrational, but their goal is to alleviate their uneasiness.
• Social anxiety disorder is the fear of being judged negatively by other people while in social situations- including fear of public embarrassment, fear of intimacy, stage fright, and fear of humiliation. Sometimes, one’s fear can be so big that they avoid social situations and human contact to the point that it interferes with their everyday living.
• Post-traumatic stress disorder (PTSD) is a form of anxiety that comes from trauma. It often leads to flashbacks and people tend to change their behavior in order to avoid the flashbacks which are triggers to feeling anxious.

Anxiety and depression

Anxiety and depression are two branches of the same tree. People who have an anxiety disorder are often presenting symptoms of clinical depression, as well. It’s incredibly rare for someone to experience one without the other. That is to say, to feel depression without feeling anxiety. They have many overlapping symptoms such as trouble concentrating, fatigue, sleeping issues, and irritability. However, there are some distinguishing symptoms between the two. People who are depressive have flattened or dulled reactions and slower movements. People who are anxious struggle to manage their anxious thoughts and fear about the future much more than people who feel depressed. The people who are depressed and who don’t experience any sort of uneasiness or anxious state often resign to believing that the future is bad.

Symptoms of anxiety

Each anxiety disorder comes with its own set of symptoms. However, the most common overall symptoms of anxiety include, but are not limited to:  

• Dizziness
• Back pain
• Sweating
• Trembling
• Easily scared or startled
• Blood clots
• Muscle tension
• Avoidance of situations that cause nervousness
• Fatigue
• Restlessness
• Increased heartbeat or irregular heartbeat
• Hypertension
• Constant feelings of worry, even without stressors

Causes of anxiety

• Genetics.
• Brain chemistry. One study found that there are some “chinks in the brain chemistry” that make some people more susceptible to being anxious than others.
• Environmental factors and everyday factors such as family, school, jobs, traumatic events, relationships, and finances. One study even found a relationship between feeling anxious and high-altitudes (due to a shortage of oxygen). Everyday factors are the most common triggers of excessive anxiety.
• Medical factors. These can include the side effects from certain medications, stress from underlying medical conditions, or symptoms from another medical condition.
• Withdrawl or use of illicit substances such as drugs and alcohol.

Anxiety can come from just one of these causes, or it can be a combination of more than one. For example, someone might feel anxious when they feel stress at work (environmental factor) and they go drinking because of it (use of an illicit substance) which creates a lot of anxiety.

Anxiety

How anxiety affects the body

When you first experience anxiety, your adrenal system produces cortisol which turns into glucose in the liver. When glucose, the high-energy blood sugar, isn’t absorbed, it can damage the liver. The throat muscles spasm because fluids are diverted to other, more essential places in the body. This makes it hard to swallow. The skin becomes clammy, sweaty, and our sympathetic nervous system pushes blood flow into our muscles (good in the beginning, but with time, it can make your skin age faster). The spleen discharges more red blood cells and white blood cells. Blood flow increases by about 300%-400%. Furthermore, there are tender muscles which can cause headaches and a stiff neck and shoulders.

After a while dealing with anxiety, the heart becomes at increased risk for cardiovascular problems because of the constant elevated blood pressure, rapid heart rate, and constant exposure to cortisol. Our lungs are affected. It’s been shown that there is a relationship between those who suffer from asthma and those who suffer from an anxiety disorder. Our immune system becomes suppressed and worn down. You’re more likely to catch a cold when under lots of stress. The stomach begins to badly regulate our digestion. Our metabolism can be affected which can lead to obesity or general weight gain. Research has found a connection between feeling anxious and physician-diagnosed ulcers. Research has also found that the constant release of cortisol, the big stress hormone, in the bloodstream actually lowers one’s insulin sensitivity.

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How anxiety affects the brain

While the body responds in a rather large way to anxiety, the brain is what is most affected. It’s believed that the hippocampus and the amygdala are what causes anxiety. The hippocampus is our emotional memory and links itself to the amygdala which regulates our emotions, such as fear and uneasiness, and helps stimulate the sympathetic nervous system. People who have lots of activity and emotional stimuli in the amygdala tend to also feel anxious. Research has shown that people who, as infants, were vigilant, fearful, and highly apprehensive, have a nucleus accumbens that is more sensitive and more anxious about making a decision than others.

Chronic anxiety can affect the brain in many ways including influencing long-term memory, short-term memory and change the chemical production of the brain which causes an imbalance. Chronic anxiety also can activate the nervous system constantly which causes wear-and-tear on both the body and the brain as well as a buildup of immunity to the system. It’s been proven that chronic worry and constantly feeling anxious can cause brain damage and lead to a higher risk of psychiatric disorders. There are some people who believe that “overpotentation”- too much of an increase in nerve impulses- of the limbic system (a system which includes the amygdala) gives way to a future of being anxious and worried. However, this belief hasn’t been 100% proven yet.

Risk factors for anxiety

Risk factors include:

• Genetics cause about 43% of panic disorders and 28% of generalized anxiety disorders.
• Neuroanatomy
• Socially, feeling uneasy and anxious can easily arise if people don’t feel comfortable being around other people.
• Psychologically, such as having poor coping skills can cause anxiety.
• Substance abuse with things like drugs, alcohol, and caffeine.
• Underlying medical conditions such as depression. Terminal cancer has been (logically) proven to cause feelings of worry and uneasiness.

Anxiety

Diagnosis of anxiety

Anxiety is diagnosed by a medical professional. Typically, the doctor takes a careful look at family history and medical history as well as performing a physical examination. In some cases, laboratory tests are necessary to provide information about medical conditions that could be causing the anxiety symptoms.

In order to be diagnosed with a generalized anxiety disorder (GAD), the most common type, someone must:

• Have difficulty with controlling the worry
• Feel excessive worry about several different events on more days than not for at least six months.
• Have at least three anxious symptoms on more days than not during the last six months. These symptoms can include irritability, restlessness, difficulty sleeping, fatigue, muscle tension, and difficulty concentrating.
• Symptoms that interfere with daily life to the point that the person misses school or work.

Treatments for anxiety

Treating anxiety depends on the underlying medical conditions and personal preference. Treatments often include a combination of therapy and medication.

Therapy, whether it be psychotherapy (talk therapy) or cognitive-behavioral therapy (CBT), is the standard treatment. The goal of psychotherapy is used to explore the causes of why someone feels anxious and the ways they can learn to cope with it. It’s conducted by a trained health professional such as a counselor, social worker, psychiatrist, or psychologist. The goal of cognitive-behavioral therapy is to change the thinking patterns that the person has associated with anxious feelings and help the person change the way they react to the situations and triggers. CBT is an exposure-based therapy that helps people confront their fears. For example, someone who goes to cognitive behavioral therapy for a panic disorder learns that panic attacks aren’t actually heart attacks. Studies show that CBT is effective in combating anxiety. A study from Saint Louis University Medical Center shows that exposure therapy is useful in helping fight anxiety. There are even studies about online CBT!

Medications are the other type of treatment often used. When being uneasy and anxious has a physical cause, such as hypertension or an imbalance in brain chemistry, medication is used. This medication can include beta-blockers, buspirone, monoamine oxidase inhibitors (MAOIs), benzodiazepines, tricyclics, and antidepressants. Benzodiazepines are highly addictive, but they have few side effects. Common benzodiazepines are Valium or Diazepam. Tricyclics are a classic version of serotonin reuptake inhibitors (SSRIs) that work well for anxiety disorders (Excluding Obsessive-Compulsive Disorder). They have side effects such as weight gain and dizziness. Some of these include clomipramine and imipramine. Antidepressants are designed to treat depression, but because they often go hand-in-hand, if the depression lessens, so will the anxious feelings. Serotonin reuptake inhibitors (SSRIs) are used often and have fewer side effects than classic antidepressants. Some of these include Celexa (citalopram), and Prozac (fluoxetine).

Anxiety

Tips to deal with anxiety

• Relaxation techniques that help relax the physical and mental stressors. These techniques can include meditation, yoga, deep breathing exercises, and baths.
• Manage stress by learning about potential stress triggers and not procrastinating. Make sure to take time off of work or studying to relax.
• Try to be more optimistic by replacing the negative thoughts with positive ones.
• Exercise is proven to improve self-image and release brain chemicals that help us feel positive and less anxious.
• Reduce your sugar intake. Studies show that people with high sugar diets have higher levels of depression and uneasiness.
• A support network that is supportive, such as a friend or family member, to talk with when you’re feeling down or anxious.

Do you have anxiety? How do you deal with it? Let us know what you think in the comments below!

Anna Bohren

Anna is a freelance writer who is passionate about translation, psychology, and how the world works.