Anxiety Disorder

 

 

Anxiety Disorder

 

Most, if not all, have felt anxiety at some point in our life. Anxiety in simple terms is a feeling of unease. It may occur before a test, when one is stuck in traffic, running late for a meeting, or when one’s flight is delayed. Being anxious in such situations is normal. As one grows older and wiser, one becomes anxious less frequently in these types of situations. Being anxious from time to time over unknown or stressful situations is not a disorder by itself. Anxiety becomes a problem or a mental disorder when a person suffers persistent fear or worry about situations that most take as normal or routine in everyday lives such as crossing the street, taking public transportation with strangers, or waiting for the bus late at night. Taken to the extreme, persistent feeling of anxiety can become debilitating, hindering normal day to day life activities. It can eventually lead to serious mental and physical health issues such as restlessness, shortness of breath, sweating, concentration problem, or inability to fall asleep (Cleveland Clinic 2022).

Anxiety can be categorized into these different types (Muskin 2023):

• Generalized Anxiety Disorder (GAD)

This is the most common type of anxiety disorder (Mental Health UK n.d.). People suffering from GAD face symptoms of extreme worry and anxiety about many activities that are routine to other people such as socializing, working, or traveling. They frequently have a sense of foreboding and feeling that something bad is about to happen to either them or a loved one (Mayo Clinic Staff 2017). They suffer from a wide range of symptoms such as restlessness, irritability, tiredness, or profuse sweating.
 

This image from Cleveland Clinic depicts common symptoms of GAD. 

• Panic Disorder

People who suffer from Panic Disorder experience unexpected episodes of panic attacks which can cause them a strong sense of discomfort and/or fear. Panic attacks can manifest with symptoms akin to those of a heart attack, such as rapid and irregular heartbeats, sweating, nausea, breath shortness, and trembling (Mayo Clinic Staff 2018).  Severe panic attacks can have debilitating effect on people, making them think that they are about to die.

This image depicts common symptoms of panic disorder

• Phobia

Phobia means fear. As a disorder, Phobia is a fear of an object, activity, situation, or people of certain characteristics. Some common phobias are, arachnophobia (fear of spiders), aviophobia (fear of flying), nyctophobia (fear of darkness), acrophobia (fear of heights), and claustrophobia (fear of tight spaces) (Depressionals n.d.). In extreme cases, people suffering from phobia will experience the same common symptoms of other anxiety disorders as depicted in the image below:

 

• Social Anxiety Disorder

This is a type of phobia which is also known as social phobia. Those who suffer from this disorder are fearful and apprehensive of social situations, especially if they think that they will be observed or scrutinized by those around them. In extreme situations, it can lead to social avoidance and isolation, which can lead to serious negative impacts on a person’s life and mental well-being.

 

 

• Obsessive-Compulsive Disorder (OCD) 

 

People who suffer from OCD suffer from unwanted thoughts and phobia that makes them do frequent and repetitive compulsive things. In extreme cases, they may suffer long lasting obsessions that could hinder their daily lives (Mayo Clinic Staff 2023). OCD usually has a thematic nature like obsession with symmetry, or cleanliness, or constant fear of contamination. We all have seen it among our friends or relatives, especially at the height of COVID pandemic, when people in restaurants would stay at the wash basin, washing their hands for a long time. 

 

• Separation anxiety

 

 

This type of anxiety mostly occurs in children. For some, it is a normal stage of development. It is associated with a feeling of unease or fear of being alone when a parent or caregiver leaves the child in the care of others with whom the child may not be very familiar (Mayo Clinic Staff 2021). Although, it is normal for many children to show signs of separation anxiety, most will grow out of it. For those who carry it into later stages of childhood, if left untreated, the child may develop more severe symptoms like a fear of future separations, difficulty sleeping, or frequent nightmares.

---

 

Anxiety Disorder is a Condition not a Condemnation

According to the World Health Organization (WHO), one fourth of the global population suffers from some form of anxiety disorder (WHO 2023). Among different forms of anxiety disorder, Generalized Anxiety Disorder (GAD) is the most common as one fifth of the global population suffers from it (Mind Help n.d.). Social Anxiety Disorder is estimated between 5 and 10% of the global population (Cleveland Clinic medical professional 2022), lifetime phobia is estimated between 2.6% and 12.5% (National Library of Medicine 2017), and Obsessive Compulsive Disorder (OCD) is estimated at 2% (Sasson n.d.).

 

Regardless of the type of the anxiety disorder, statistics show that women suffer more than men (National Library of Medicine 2011).

 

Statistics show that the onset of anxiety disorder is usually at a younger age. On the other hand, the prevalence rate of anxiety disorders among age groups appears to be more or less flat. One can conclude that, although anxiety disorders tend to start earlier in age, most people keep their anxiety as they age. The two charts below show these statistics (Javaid 2023).

In a study conducted among 617 Australians, aged 18 to 65, by the Australian National University, between 30 and 60 percent of respondents attached some sort of stigmatization to anxiety disorder (Australian National University n.d.).

 

 

Even 1% of people stigmatizing anxiety disorder is 1% too many let alone 30+ percent.

People with an anxiety disorder need help not blame or stigmatization. Unfortunately, they may experience discrimination or negative attitudes from others. This usually is because of society associating stigma to anxiety disorders. These are some common types of stigmatization associated with anxiety disorders.

• Dismissive attitudes and trivialization

 

 

Many people think that those with anxiety disorders are weak and cannot live or work independently. This is risky. It can lead to wrong ideas about anxiety disorders such as thinking that the symptoms of the disorder are due to some personal or physical deficiency on the part of the person who suffers from it. People who suffer from anxiety disorder need support and confidence. Belittling or stigmatizing them will not help the situation. Some do not take anxiety disorders seriously and think that people can just stop fussing about or stop being anxious for no reason (Australian National University n.d.). This ignores the difficulty faced by those who suffer from the disorder and robs them of the help and support they need to overcome their problems.

• Stereotyping

Stereotyping is a kind of generalization. It assigns a label to a person or a group of people. It can make the stereotyped person feel that they do not belong. It is not uncommon for people with anxiety disorders to be stereotyped and regarded as insane, retarded, weird, dangerous, or unpredictable (Griffiths n.d.). Stereotyped individuals may feel a sense of isolation or detachment from society and may grow reluctant to discuss their disorder and seek help (Beyond Blue n.d.). In extreme cases, victims of stereotyping may suffer from lack of self-worth, depression, or even suicidal thoughts.  

• The Blame Game

 

People with anxiety disorders may suffer blame by others who may think that they are responsible or have done something wrong to have the disorder (Phelan 2004). This attitude does not take into consideration the environmental or societal conditions that may have contributed to the disorder in a person. It may also exacerbate the magnitude of the syndrome in the person who suffers from it – simply put, it may make them more anxious as they may become hesitant of taking any action or being in any group for fear of being blamed for their anxiety.

• Cultural and Gender Expectations

In some cultures, men may be expected to be strong and not display emotions publicly. This may prevent them from sharing their anxiety disorder and seeking help. Women, on the other hand, may be regarded as the weaker sex being whiny and over dramatic if they talk about emotional problems such as anxiety disorders. This kind of expectations may unfairly stigmatize people and prevent them from seeking help when they need it.

---

 

How to Help

 

We, as individuals, and society, as a whole, must be compassionate and accommodating towards those who have anxiety disorders. We should avoid stigmatizing them or their affliction. There are a number of ways that we can lessen the stigma around anxiety disorders. These include:

•    Education and Awareness

Through education, we can make people understand the root causes of anxiety disorders. We can help people know why those with the disorders behave in ways that may differ from others. One of the worst things one can do is to label those with a spell of anxiety disorders as temperamental, weird or crazy and leave them on their own. Education can help us gain knowledge of signs and symptoms of anxiety disorder so that we recognize the behavioural manifestation of it in others; it can help us learn how to prevent or manage an episode of anxiety in others; it can teach us how to be supportive without being condescending or dismissive (Beyond Blue n.d.). 

•    Being supportive and Fostering

We need to understand that those suffering from anxiety disorders are suffering from an illness. In the same manner that those suffering from a physical illness may need to seek medical help, those with anxiety disorders may also need to seek medical attention. Labeling and stigmatizing their illness can marginalize them. It is important to be supportive and assure them that they are not alone, and that what they experience is a medical condition that can very well be treated. We need to make them comfortable to talk about their feelings, and the problems they are facing. We must stay away from confrontation or aggravation of the situation (McGuire, Joseph McGuire n.d.). If we know a situation that might trigger anxiety in others, we must try to prevent that situation from occurring (Priory n.d.). We must show compassion and concern without being condescending. Often, all it may take is to stay calm and listen. We must make sure that those suffering from anxiety disorders feel welcome and included and not isolated and secluded.

In the workplace, there are many situations, such as deadlines, or new projects using new technology, that may serve as triggers for employees suffering from anxiety disorders. It is essential to make sure that employees understand that they are not alone and they have the support of the team and the management. We must help employees feel that it is alright not to know something and provide them with a pathway to gain the knowledge and support they need to do their work. We must also make sure that all employees know that all ideas are welcome and there are no bad or crazy ideas. We, together, will evaluate the applicability of each idea to a project. Flexible schedules, detailed breakdown of small tasks, availability of professional consultation, and one-on-one meetings with management are tools that can be used by employers to help employees suffering from workplace-related anxiety disorders (Advanced Psychiatry Associates 2020).

Help is Closer than We Think

Barak Obama once said “Change will not come if we wait for some other person or some other time. We are the ones we've been waiting for” (Obama 2005). To educate, raise awareness about, and advocate for understanding the root causes of anxiety disorder, we must start with ourselves. Since one fourth to one fifth of the global population suffers from some sort of anxiety disorder, chances are high that someone we know suffers from it. As mentioned above, we need to learn how to recognize the symptoms, and how to stay calm and not aggravate the situation. We also need to learn where help might be sought. For more immediate help with anxiety disorder, here in my hometown of Ottawa, there are a number of organizations and hotlines such as:

-    Canadian Mental Health Association (CMHA) - Ottawa Branch

311 McArthur Ave. 2nd floor,
Ottawa, ON K1L 8M3
Phone: (613) 737-7791
https://ottawa.cmha.ca/our-services/

They provide a range of mental health services. They offer counseling and support. They have an online page about anxiety disorder at https://ottawa.cmha.ca/documents/anxiety-disorders/

-    Youth Services

2675 Queensview Drive
Ottawa, Ontario K2B 8K2
Phone: 613-260-2360
24/7 CRISIS LINE 613-260-2360
https://www.ysb.ca

They offer a range of services for young people such as counseling and crisis intervention.

-    Royal Ottawa Mental Health Centre

1145 Carling Ave.,
Ottawa ON K1Z 7K4
+1 (613) 722-6521
https://www.theroyal.ca/

They offer a range psychiatric services and counseling.
They have 

• A crisis line at

Phone: 613-722-6914 (within Ottawa)
Toll-free – 1+ (866) 996-0991 (outside Ottawa)

• A crisis page at https://www.theroyal.ca/crisis-lines
  

• An online page about mood and anxiety and their related services at https://www.theroyal.ca/patient-care-information/clinics-services-programs/mood-and-anxiety

-    Anxiety Disorder Association of Ontario (ADAO)

Heartwood House
404 McArthur Avenue
Ottawa, Ontario
K1K 1G8
Email: admin@anxietydisordersontario.ca

They have

• Multiple helpline numbers at https://www.anxietydisordersontario.ca/helplines
• List of support groups for various anxiety disorders at https://www.anxietydisordersontario.ca/specific-anxiety-related-resources
• List of treatment centers and programs at https://www.anxietydisordersontario.ca/treatment-centres-programs-and-services

-    Family Services Ottawa

312 Parkdale Ave, Ottawa, ON K1Y 4X5
1-613-725-3601
https://familyservicesottawa.org/

They have

• A mental health crisis line 1-613-722-6914
• A mental crisis page at https://crisisline.ca/
• A general crisis page at https://familyservicesottawa.org/crisis-lines/

 

For less immediate and longer term help, any of the resources above can be contacted to provide information about counselors, mental health practitioners, or doctors who may be able to help individuals with anxiety disorders. Of course, one can always seek help from their family doctors. They have the knowledge and the experience to guide us through the proper path of seeking help and treatment for those who suffer from anxiety disorder.

---

 

Treatment Options

 

There are a variety of treatment techniques and routines available to help those who suffer from anxiety disorders. It is not inconceivable that a professional therapist may recommend a combination of different treatment options. Here are a few treatment options:

-    Medication

We need to keep in mind that there is no chemical cure for anxiety. Its symptoms and triggers can be treated with certain medications. We also need to keep in mind that all medications have side effects. With these in mind, there are a number of different medications that a doctor may prescribe. Here are a few examples (Barnhart 2023):

• Benzodiazepines

These are sedatives that have a calming effect on the mind and a relaxing effect on the muscles. They are usually used for short-term relief of anxiety. Some famous brand names include Valium and Xanax. These are common side effects (Barnhart 2023):

• Drowsiness
• Confusion
• Disorientation
• Vision problems
• Headaches
• Bouts of depression 

• Buspirone

The exact biological function of Buspirone is not fully understood. Some think that it interacts with brain chemicals and regulate a person’s mood. Buspirone can be used for short-term as well as chronic anxiety disorders. It may take days to weeks for Buspirone to become fully effective. A famous brand name of Buspirone is Buspar. These are common side effects of Buspirone (Barnhart 2023):

• Dizziness
• Headaches
• Nausea
• Nightmares
• Difficulty sleeping

 

• Antidepressants

These are drugs that affect neurotransmitters. They are used to treat symptoms of anxiety. They can take days to weeks to become effective. Here are some types of antidepressants (Barnhart 2023):

• Selective Serotonin Reuptake Inhibitors (SSRIs)

They increase the levels of serotonin, which is a neurotransmitter that can affect mood. Some famous brand names are Zoloft and Prozac. Their side effects include (Barnhart 2023):

• Nausea
• Dry mouth
• Muscle weakness
• Diarrhea 
• Dizziness
• Drowsiness
• Sexual dysfunction

• Tricyclics

They function similar to SSRIs. With the exception of OCD, they can treat most anxiety disorders. They are not prescribed very often as newer drugs are favoured more. Their side effects include (Barnhart 2023):

• Dizziness
• Drowsiness
• Confusion
• Urinary retention
• Nausea
• Constipation
• Vision  problems

 

• Monoamine Oxidase Inhibitors (MAOIs)

They increase the number of neurotransmitters and regulate mood. They are usually prescribed to treat panic disorders and social anxiety. An example of a brand name for this medication is Nardil. They have more side effects than some newer medications. Their side effects include (Barnhart 2023):

• Dry Mouth
• Nausea
• Diarrhea
• Constipation
• Drowsiness
• Insomnia
• Dizziness

These medications can negatively interact with a wide range of other medications such as acetaminophen and ibuprofen and cause dangerous  levels of high blood pressure (Barnhart 2023).

• Beta-blockers

Mostly prescribed for treatment of heart conditions, they are sometimes prescribed to treat physical symptoms of anxiety disorders. Their side effects include (Barnhart 2023):

• Fatigue
• Dizziness
• Drowsiness
• Cold fingers and toes
• Insomnia
• Nausea
• Shortness of breath

-    Home Remedies and Activities

There are a number of home remedies and techniques that can be used to treat symptoms of anxiety without many side effects. Exercise increases endorphins, which is a neurotransmitter and can, in addition to helping the overall health of the body, lower stress levels, prevent the onset of an anxiety disorder, or reduce the severity of effects of the disorder. A few minutes of meditation or listening to music can help with stress levels. Chamomile tea, has shown to be helpful in reducing general anxiety levels (Barnhart 2023).

-    Cognitive Behavioural Therapy (CBT)

CBT therapists help anxiety disorder patients to first understand their issues. They then ask a number of questions and help the patient to identify the triggers and situations of their anxiety. Through a dialogue of questions and answers, both the patient and the therapist gain better understanding of the nature of the anxiety disorder that the patient suffers from. It also helps the patient to become more comfortable to talk about their feelings and levels of anxiety they experience. The therapist will then try to come up with ways for the patient to change the negative thoughts and habits that have been contributing to the patient’s anxiety disorder (Cleveland Clinic n.d.). 

CBT is a gradual therapy process that usually takes place over a number of sessions. In this process, patient and therapist form a partnership towards the common goal of helping the patient overcome their anxiety disorder (Cleveland Clinic n.d.). 

CBT can help with a number of anxiety disorders such as the ones shown below. 

-    Exposure Therapy

Originally, exposure therapy was devised as a tool to treat phobia and help patients reach a stage where they could face their phobias and be willing to be in situations which they used to avoid out of fear. Over time, exposure therapy has proven to be effective not only to treat phobias, but also to help patients with other sorts of anxiety disorders. During a course of exposure therapy, therapists create a safe environment in which patients can gradually be exposed to situations that have served as triggers for their anxiety (American Psychological Association n.d.).  

With one fourth to one fifth of the global population suffering from some type of anxiety disorder, it is a common mental health issue. Chances are that at least one person in our immediate surrounding suffers from it. We must educate ourselves about it, raise awareness around it, and de-stigmatize it. Through understanding, empathy, and compassion, we may help patients with anxiety disorders to open up about how they feel, and what makes them feel anxious. Anxiety disorders are treatable conditions. We need to learn what type of help is available so that we can talk about it, and present potential treatment options to those who suffer from anxiety disorders.

References:

Advanced Psychiatry Associates (Feb 13, 2020). How to Manage Anxiety at Work, Advanced Psychiatry Associates, https://advancedpsychiatryassociates.com/resources/blog/how-to-manage-anxiety-at-work/

American Psychological Association (n.d.). What Is Exposure Therapy?, American Psychological Association, retrieved on February 3, 2024 from https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy

Australian National University (n.d.). Generalised Anxiety Stigma Scale (GASS), Australian National University, retrieved on Feb 6, 2024 from https://nceph.anu.edu.au/research/tools-resources/generalised-anxiety-stigma-scale-gass

Barnhart, Rebecca, PharmD (February 13, 2023). Drugs to Treat Anxiety Disorder, Healthline, https://www.healthline.com/health/anxiety-drugs

Beyond Blue (n.d.). Stigma relating to anxiety, Beyond Blue, retrieved on January 17, 2024 from https://www.beyondblue.org.au/mental-health/anxiety/stigma-relating-to-anxiety

Bridges to Recove (n.d.). Panic Disorders, Bridges to Recovery, retrieved February 2, 2024 from https://www.bridgestorecovery.com/panic-disorder/

Cerebral (July 8, 2020). Social Anxiety Disorder Signs And Symptoms, Cerebral, retrieved on January 17, 2024 from https://cerebral.com/blog/social-anxiety-disorder-signs-and-symptoms

Cleveland Clinic (n.d.). Cognitive Behavioral Therapy (CBT), Cleveland Clinic, retrieved February 3, 2024 from https://my.clevelandclinic.org/health/treatments/21208-cognitive-behavioral-therapy-cbt  

Cleveland Clinic (August 2, 2022). Generalized Anxiety Disorder (GAD), Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/23940-generalized-anxiety-disorder-gad

Cleveland Clinic medical professional (April 10, 2022). Social Anxiety Disorder (Social Phobia), Cleveland Clinic, retrieved on February 2, 2024 from https://my.clevelandclinic.org/health/diseases/22709-social-anxiety

Depressionals (n.d.). Phobia Disorder: Causes, Types, Symptoms & Treatments, Depressionals, retrieved on January 17, 2024 from https://depressionals.com/phobia-disorder/

Griffiths, K.M., Batterham, P.J., Barney, L., & Parsons, A. (n.d.). Generalised Anxiety Stigma Scale (GASS), ANU College of Health & Medicine, retrieved February 5, 2024 from https://nceph.anu.edu.au/research/tools-resources/generalised-anxiety-stigma-scale-gass

Javaid, S.F., Hashim, I.J., Hashim, M.J. et al. Epidemiology of anxiety disorders: global burden and sociodemographic associations, Middle East Curr Psychiatry 30, 44 (2023). https://doi.org/10.1186/s43045-023-00315-3

Mango Clinic (July 14, 2021), 11 Best Proven Ways of Helping Someone with Anxiety, Mango Clininc, https://mangoclinic.com/11-best-proven-ways-of-helping-someone-with-anxiety/

Mayo Clinic Staff (April 05, 2021). Separation anxiety disorder, Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/separation-anxiety-disorder/symptoms-causes/syc-20377455

Mayo Clinic Staff (May 04, 2018). Panic attacks and panic disorder, Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021

Mayo Clinic Staff (Dec. 21, 2023). Obsessive-compulsive disorder (OCD), Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432

Mayo Clinic Staff (Oct. 13, 2017). Generalized anxiety disorder, Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803

McGuire, Joseph McGuire, (n.d.). How to Help Someone with Anxiety, John Hopkins Medicine, retrieved on February 2, 2024 from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/how-to-help-someone-with-anxiety

 

Mental Health UK (n.d.), Types of anxiety disorders, Mental Health UK, retrieved on January 16, 2024 from https://mentalhealth-uk.org/help-and-information/conditions/anxiety-disorders/types/

Mind Help (n.d.), Generalized Anxiety Disorder (GAD), Mind Help, retrieved on February 2, 2024 from https://mind.help/topic/generalized-anxiety-disorder/

Muskin, Philip (June 2023). What are Anxiety Disorders?, American Psychiatric Association, https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders

Obama, Barak (Feb 5 2005). Barack Obama’s Feb. 5 Speech, The New York Times, retrieved on Feb 4, 2024 from https://www.nytimes.com/2008/02/05/us/politics/05text-obama.html

Sasson, Y, et al (n.d.). Epidemiology of obsessive-compulsive disorder: a world view, National Library of Medicicine, retrieved on February 2, 2024 from https://pubmed.ncbi.nlm.nih.gov/9393390/

National Library of Medicine (Mar 25, 2011). Gender Differences in Anxiety Disorders: Prevalence, Course of Illness, Comorbidity and Burden of Illness, National Library of Medicine, retrieved on February 2, 2024 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135672/

National Library of Medicine (Feb 22, 2017). The cross-national epidemiology of specific phobia in the World Mental Health Surveys, National Library of Medicine, retrieved on February 2, 2024 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674525/

Phelan, Jo, C., Link, Bruce G. (n.d.). Fear of people with mental illnesses: the role of personal and impersonal contact and exposure to threat or harm, National Library of Medicine, retrieved on February 2, 2024 from https://pubmed.ncbi.nlm.nih.gov/15179908/

Priory (n.d.). How to Help Someone with Anxiety, Priory, retrieved on February 2, 2024 from https://www.priorygroup.com/mental-health/anxiety-treatment/how-to-help-someone-with-anxiety

Psych Central (May 6, 2022). The Basic Principles of Cognitive Behavioral Therapy, Psych Central, https://psychcentral.com/pro/the-basic-principles-of-cognitive-behavior-therapy 

WHO (27 September 2023), Anxiety disorders, WHO, https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders

Your Counseling (n.d.). How To Manage Anxiety and Stress, Your Counseling, retrieved January 16, 2024 from https://www.yourcounselling.ca/how-to-manage-anxiety/