Understanding and managing anxiety

Did you get nerves ahead of your wedding? Do your palms sweat when you start a presentation at work? When you were in school or college, did you have difficulty sleeping the night before an exam? If your answer to any of these questions is yes, do not fret. You are like most people for whom a certain amount of worry, fear, anxiety or stress is a normal and expected part of life.

However, anxiety can be a disorder when it begins to ‘take over’ an individual’s life to a large extent and interferes with their daily activities, school, work and/or relationships. When a person suffers from an anxiety-related disorder, their fears and worries do not simply fade away after an event; they usually get worse over time.

Let’s understand more about anxiety-related disorders and how they can be managed.

Are you merely anxious or is it a disorder?

A good way to distinguish normal worries and fears from a disorder is to identify the cause of the anxiety and assess if the symptoms are disproportional and exaggerated. For instance, being uncomfortable amidst a crowd or feeling nervous among people does not necessarily constitute a disorder. However, if the fear of crowds prevents a person from stepping outside their home and leading a normal life, they are likely suffering from an anxiety-related disorder. That said, it can be tricky to decide if the symptoms a person experiences are natural or linked to a disorder. Hence, if you have anxiety issues but you are unable to ascertain whether or not it is natural, consult a professional.

Anxiety-related problems are both commonplace and misunderstood

Anxiety-related disorders are some of the most common forms of mental illness. Still, they are usually mismanaged and poorly understood.

According to the WHO, depression, and anxiety are together responsible for 40 percent of disabilities in the world today. The latest Psychiatric Morbidity Survey indicates that around 6 million people in the UK suffer from depression and anxiety-related disorders. Another survey shows that in the US, 40 percent of adults have experienced an anxiety-related disorder at some point in their lives, but only a third among them have received treatment.

The way society deals with anxiety-related disorders is equally distressing.

It is not unusual to feel alone and misunderstood if you are struggling with anxiety issues. To make matters worse, people who are worried or anxious are often advised to ‘just let it go’ or ‘snap out of it’. Anxiety sufferers are told that their fears are unwarranted or even silly, and their jumpy behaviour is treated with scorn. There are so many different kinds of anxiety-related fears that what you consider a normal, everyday occurrence may trigger a panic attack in another person. Consequently, anxiety sufferers find it difficult to seek help, even from their loved ones, and their struggle becomes harder.

Although their severity and extent remain largely unacknowledged, anxiety-related disorders can be as debilitating as any physical disease. Therefore, to begin the recovery process, it is essential to consult a healthcare professional as well as discuss the problem honestly and in detail with friends and family. While it may be initially difficult to convey your predicament, continuous communication with your loved ones is the key to manage any anxiety-related disorder.



Anxiety becomes a disorder when it begins to interfere in your daily activities.


What are the risk factors of anxiety-related disorders?

Physiologically, anxiety is a process in which the hormone adrenaline is generated in the body to enable you to cope with any unusual or dangerous situation. Problems arise when this response is out of sync with the actual intensity of the danger or situation. It may occur that a response is generated even without any unusual or dangerous situation.

Although the exact causes of anxiety-related disorders are not yet completely understood, there are many triggers or risk factors. These include:

  • Chronic or acute stress
  • A traumatic life experience
  • Poor quality of life and relationships
  • Lifestyle-related conditions such as insomnia and loneliness
  • Behavioural choices such as alcohol and drug abuse, excessive caffeine use or an inactive lifestyle
  • Heredity reasons
  • Biochemical imbalances in the brain
  • Physical ailments such as thyroid problems, diabetes, heart disease, respiratory disorders
  • Chronic illnesses such as irritable bowel syndrome and auto-immune diseases
  • Other mental health conditions such as depression and bipolar disorder
  • Stressful or negative environments in childhood
  • Temperamental traits such as shyness or behavioural inhibition
  • Clinical reasons such as side-effects of medications or substance withdrawal treatments


What are the symptoms of anxiety-related disorders and when should you see a doctor?

Scientists believe that anxiety was a necessary part of our evolution. Many of the symptoms of anxiety, such as a ‘flight or fight’ response, worrying and being on guard, played a crucial role in the survival of early human species. Think of a hunter-gatherer in the savannah grasslands. If they were not anxious or on their toes, constantly looking over their shoulders, they would be easy prey for animals.

Today, we continue to have those anxiety-related responses, even though most everyday occurrences and life situations are neither adverse nor dangerous. Sometimes, such responses can be extremely exaggerated, especially when one or more of the risk factors mentioned earlier are present.

There are various types of anxiety-related disorders, and their symptoms often overlap. In general, however, all anxiety-related ailments are characterised by chronic worry, heightened nervousness and a fear that is constant, excessive and disruptive. Some physical symptoms of such disorders include nausea, sweating, dry mouth, shortness of breath, tremors, tightness in the chest, an increase in heartbeats and an urge to pass urine. Psychological symptoms include nervousness, irritability, fear of losing control, restlessness, dread about something extreme (such as death and disaster), palpable tension and agitation.

As we have discussed before, you should consult a doctor to:

  • Ascertain if the anxiety-related symptoms you are experiencing are natural or linked to a disorder
  • Begin the recovery process if your anxiety-related symptoms are overwhelming you and preventing you from functioning normally

Additionally, it is a good idea to consult a doctor if:

  • Anxiety is leading an individual to substance/alcohol abuse or vice versa
  • An individual has suicidal thoughts or behaviours

What are the various types of anxiety-related disorders?

Anxiety-related disorders are divided into three main categories:

  • Anxiety disorders
  • Obsessive-Compulsive and related disorders (OCD)
  • Trauma and stressor-related disorders

While anxiety disorders are characterised by general fear, nervousness, anxiety, and negative emotional consequences, OCDs are described as obsessive thoughts (most commonly about cleanliness) that trigger compulsive behaviours (such as repeated hand-washing). Trauma and stressor-related ailments are caused by traumatic life events (such as the untimely death of a loved one or an accident) or major stress-inducing situations, such as moving homes, divorce, having a baby and starting college.

There are several types of anxiety disorders. The major ones include:

  • Generalised Anxiety Disorder (GAD): GAD is a long-term condition that makes you anxious about a wide range of situations even when nothing is really wrong. Characterised by chronic worry, fatigue, and restlessness, GAD occurs when a person’s worry is disproportionate to the actual risk.
  • Panic disorder: This type of anxiety shows up as recurring episodes of intense fear and anxiety or panic attacks where the fear reaches peak level within minutes. Typically, an individual with panic disorder keeps worrying about the return of panic symptoms, which creates a cycle of tension and worry.
  • Phobia-related: Phobias are persistent and excessive fears about specific situations or objects, and they often cause panic attacks. More often than not, the fear is unreasonable and irrational. A person may have
    • Specific phobias such as the fear of flying, fear of heights and fear of insects.
    • Social phobia, which makes a person terribly afraid of being humiliated or embarrassed in a social situation.
    • Agoraphobia, which makes a person extremely fearful about being in (or anticipating) a situation from where escape seems impossible. Examples of agoraphobia include the fear of crowded public places, enclosed spaces or being alone at home.
  • Selective mutism: This is a relatively rare disorder in which the sufferer fails to speak in certain social situations despite being perfectly capable of doing so. For instance, an otherwise talkative child may refuse to speak in school because of various reasons such as fear of the teacher and discomfort with a particular language.
  • Separation anxiety disorder: More commonly found in children, this disorder is characterised by excessive anxiety when one is separated from a parent or a loved one.
  • Substance-induced anxiety disorder: This disorder occurs as a result of drug or alcohol abuse or withdrawal from drugs and other toxic substances. It is characterised by intense anxiety and/or panic.
  • Anxiety due to a medical condition: Several physical and mental health conditions can induce anxiety. Anxiety issues can also be a side-effect of some medications.


What are the various treatments for anxiety-related disorders?

There are many occasions where anxiety is valid or useful. So, medically, it is considered a normal emotion and not ‘curable’ as such. Nonetheless, those suffering from anxiety-related disorders may look at a combination of self-help strategies, lifestyle and behavioural modifications as well as therapy and medications (in extreme situations) to overcome their symptoms. Medical professionals often talk in terms of coming to a point where the individual recognises and manages their anxiety rather than anxiety controlling and affecting their work and life. In other words, anxiety sufferers can put themselves on the path to recovery simply by understanding that their cure largely lies in looking inwards.

How can you cope with or prevent anxiety-related disorders?

As we have said before, anxiety can be beneficial. For instance, it can push an individual to work harder to achieve a target or make a person more vigilant about possible danger. However, when symptoms become difficult to manage, certain strategies can be adopted to prevent normal anxiety from turning into a disorder. A few tips are listed here.

  • Maintain a healthy and active lifestyle
  • Learn how to relax
  • Nurture your social and family life
  • Be aware of your triggers


Originally written 6th December 2018