Anxiety

What Are the Main Signs and Symptoms?

If you have several symptoms, and their frequency, intensity, and/or duration are high, you may have or be developing an Anxiety Disorder. The signs of this condition can manifest in different domains:

1) Behavioral and Cognitive Domain:

• Perception of constant danger;
• Behaviors of avoiding situations that one would normally be able to handle;
• Social isolation;
• Negative thoughts related to failure and self;
• Excessive and/or constant worry about yourself, others, and/or the future;
• Altered sleep patterns that can lead to frequent insomnia and/or nightmares.

2) Emotional Domain

• Intense or persistent fear in various life situations;
• Constant irritability as if on the verge of 'implosion';
• Feeling a mixture of unexpressed and sometimes contradictory emotions.

3) Physical Domain

• Muscle tension and/or muscle pain and susceptibility to injuries;
• Constant fatigue;
• Difficulty breathing and a feeling of shortness of breath;
• Cold sweats;
• Dizziness;
• Rapid heartbeats;
• Frequent and unexplained headaches;
• Nausea and/or vomiting.

What Types Exist?

Anxiety Disorders share some central signs and symptoms, but they can be distinguished based on the type of fear-inducing situations/avoidance behaviors and associated beliefs and thoughts. Some types of Anxiety Disorders tend to co-occur.

Separence Anxiety - A sense of fear or anxiety when separation from significant people is anticipated. This anticipation also involves the fear that something painful or catastrophic will happen during the separation, with a feeling that one cannot take care of themselves in those circumstances. Separation Anxiety typically involves some form of resistance to separation from significant people.

Selective Mutism - A disorder characterized by a consistent inability to speak in certain social situations, even though the individual has no difficulty speaking in other situations. This inability has significant consequences for academic, professional, and social performance.

Performance Anxiety - Fear of not meeting certain challenges, having high standards of self-demand, and not being able to appreciate every success because one feels it could have been better. It can be present in family, professional, and social roles and even in leisure activities. This type of anxiety is often linked to perfectionism, leading to frequent self-anger whenever one fails to achieve what was anticipated. Performance Anxiety is also linked to the fear of disappointing others and being seen as weak, incapable, or lacking resources.

Specific Phobias - Immediate onset of intense anxiety and panic when faced with a specific situation, object, or stimulus (e.g., an animal). These are consistently avoided or faced with intense irrational fear that is exaggerated both in terms of the risk the situation poses and the sociocultural context of the individual. Unlike several other Anxiety Disorders, this type is not associated with cognitions, as the fear and avoidance are automatically induced by the phobic situation.

Social Anxiety - Anxiety and avoidance of social situations that involve the possibility or anticipation of criticism, observation, or scrutiny by others, especially strangers. It also includes situations where the person has to perform tasks they are not sure of, such as public speaking or situations that the person usually handles comfortably, like eating or drinking. In these situations, there is a fear of being negatively evaluated by others and feeling embarrassment, humiliation, or rejection.

Panic Disorder - While anxiety involves the anticipation of a future threat, panic consists of a particular type of fear response to a perceived immediate threat. These reactions are extremely intense and uncontrollable, and can be unexpected and recurrent. Once a person has their first panic attack, they start to think: 'What if I have a panic attack? What if I feel unwell?' This process, called rumination, is a trigger for new panic episodes. Living in constant fear and monitoring all physiological signs, as if one were constantly afraid of dying due to the intensity of each episode. Panic attacks usually occur at rest and lead the person to start avoiding places like shopping centers, bridges, concerts, public transport such as subways, planes, cars, or buses - situations where they feel there is no escape.

Agoraphobia - This condition may or may not be combined with Panic Disorder. People with Agoraphobia feel intense fear and/or anxiety in two or more of the following situations: using public transportation; being in open spaces/outdoors; being in small spaces or crowded places; being in lines or in the middle of a crowd; being away from home, alone, in various situations. There is an anticipation of felt embarrassment or that other people notice their anxiety signs, causing even more discomfort. Often, these individuals need to be constantly in the company of someone they trust to perform tasks that others would do alone.

Generalized Anxiety Disorder (GAD) - The signs and symptoms of this condition include persistent and excessive anxiety and worry about various domains. Adults with GAD typically worry about topics related to daily life, daily routines, professional and domestic responsibilities, health, and finances. Children with GAD tend to excessively worry about their competence and the quality of their performance. The intensity, duration, and frequency of these symptoms are disproportionate to the probability or impact of the anticipated event, and during the course of the disorder, the focus of worry can shift between different subjects. The person has difficulty controlling worry and preventing it from interfering with their tasks. Additionally, physical symptoms such as restlessness, muscle tension, or nervousness are experienced. Those with this condition tire easily and have difficulty concentrating, and their mind often goes 'blank.' Feelings of high irritability and disturbances in usual sleep patterns may also occur, and the person is constantly on alert.

Anxiety Disorder Induced by Medication/Substance/Medical Condition - Anxiety associated with substance intoxication, withdrawal, medical treatment, or as a physiological consequence of another medical condition.

What Are the Possible Causes and Risk Factors?

Biological Factors

In the case of some Anxiety Disorders, genetic inheritance plays a role, and certain genetic markers that increase vulnerability to these disorders have been identified.

Environmental Factors

Traumatic situations or events and the abuse of certain substances have been linked to the onset of Anxiety Disorders. Environments characterized by excessive protection, invalidation, or physical and/or emotional abuse are also related to the emergence of clinical anxiety symptoms. Unexpected and distressing life events (e.g., divorce, death of a family member/friend, immigration, change of residence, accidents, unemployment, parenthood, among others) can trigger Anxiety Disorders.

What Is the Prevalence and Mortality?

Anxiety tends to affect various age groups, socioeconomic strata, and genders. Many Anxiety Disorders begin to develop in early life stages. When not addressed through psychotherapeutic intervention in a timely manner, they continue to develop, and episodes and symptoms tend to persist and increase in frequency, intensity, and duration.

Individuals with Anxiety Disorders are more likely to experience thoughts of suicide and engage in suicide attempts. Panic Disorder, Generalized Anxiety Disorder, and Specific Phobias are Anxiety Disorders most strongly associated with the transition from suicidal thoughts to suicide attempts.

How Can Psychotherapy Help?

First and foremost, seeking help does not mean you are weak or incapable, two labels that people with Anxiety Disorders try to avoid at all costs. Anxiety is a global public health problem that can lead to suicide: the earlier you start psychotherapy, the easier and faster the recovery will be. The effectiveness of psychotherapy for Anxiety Disorders is scientifically proven, and there are various approaches that can help in these cases, including:

• Cognitive-Behavioral Therapy (CBT);
• Emotion-Focused Therapy (EFT);
• Existential Therapy;
• Eye Movement Desensitization and Reprocessing (EMDR), in cases involving traumatic situations;
• Mindfulness.

From the very beginning, you will be introduced to the functioning of anxiety, making it easier to regulate all associated emotions, thoughts, and behaviors. You can work on identifying the 'triggers' that generate anxiety and acquire strategies to reduce and control it, using relaxation techniques, emotional self-regulation, meditation, and focus, among others.

Family, romantic, and peer relationships are also an important dimension in the context of anxiety, due to their relational influence base, in terms of symptom maintenance and expression. Therefore, the field of relationships can also be a therapeutic focus (individually or through family therapy).

Some of the main therapeutic objectives will include learning to: reevaluate fear- and panic-inducing situations, seeing them less as imminent threats and more as challenges that can be managed; facing avoided and feared stimuli, as avoidance is an important factor in anxiety maintenance; and, when necessary, resolving deeper conflicts underlying anxiety symptoms that may not be conscious. Seeking psychotherapy for anxiety can help you regain your quality of life and overcome the sense of paralysis caused by this condition, increasing your self-efficacy and well-being.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association.

Forsyth, J. P., & Eifert, G. H. (2016). The mindfulness and acceptance workbook for anxiety: A guide to breaking free from anxiety, phobias, and worry using acceptance and commitment therapy. New Harbinger Publications.

Koenigsberg, J. Z. (2021). Anxiety disorders: Integrated psychotherapy approaches. Routledge/Taylor & Francis Group.

Saliani, A. M., Barcaccia, B., & Mancini, F. (2011). Interpersonal vicious cycles in anxiety disorders. In M. Rimondini (Ed.), Communication in cognitive behavioral therapy (pp. 149-183). Springer Science + Business Media.

Wolfe, B. E. (2005). Understanding and Treating Anxiety Disorders: An Integrative Approach to Healing the Wounded Self. American Psychological Association.