Anxiety is a normal and healthy reaction in most cases, and it is triggered when a person must face some sort of threat or danger. Anxiety becomes a disorder when the person feels fear and excessive worry, either when facing their relationships with family, friends, or peers, or regarding their performance at school or work, which ends up affecting their day‑to‑day wellbeing and diminishing their freedom and autonomy.
Anxiety Disorders explained in first person
When anxiety becomes a disorder, it doesn’t allow us to do the things we like to do and it is how long it lasts.
Anxiety is an emotion that everyone has experienced at some point, which helps the body prepare to do something important. Anxiety produces a psychophysiological reaction, which intensely activates the central nervous system and the whole body. It appears when a person must act in a situation that demands intense or sustained effort, and serves to activate the individual to help them cope with a threat or danger occurring in the present or that will happen in the future.
Therefore, anxiety causes changes in body’s different systems by activating them, so that they are prepared to act and help the body to respond quickly.
Anxiety is a normal and healthy reaction in most cases. For example, when one faces a job interview or an exam it can be useful because it puts us on ‘alert’. The person might notice some physical changes such as their heart beating faster or they may have a dry mouth, but these feelings will decrease during the interview or the exam. Even before the interview or the exam, the person may feel these sensations and have some thoughts about what they will experience, for instance, that the interviewer might be very hard on them or the questions very difficult.
For those who experience anxiety, it is important to keep in mind that it is a normal emotion, because the objective cannot be to eliminate it but rather, to learn to tolerate it and manage it.
Anxiety and mechanisms in the brain
The reactions caused by anxiety originate in mechanisms in the brain. Human brains are very good at integrating information from the past (memories) with information from the present (situations) to anticipate and foresee the future (consequences).
Information from the past, or memories, is formed by lived experiences linked to the emotions and bodily sensations that were felt in that situation. Remembering the past revives the emotions and feelings that were felt at that time.
Some parts of the brain store the information that was collected from the outside through the sense organs, while others provide information stored about the emotions and internal sensations that had been felt. These various parts of the brain work and are activated cooperatively. When a situation from the present resembles some previous memory or experience, the same feelings and associated emotions are easily activated. If this situation resembles the memory of an experience that made you feel afraid in the past, it can easily evoke the same reaction in the present as well.
What are Anxiety Disorders?
Anxiety disorders are characterized by intense fear or anxiety and/or excessive worrying. These disorders affect people of all ages and generate significant discomfort and impact the person’s normal functioning (either in relation to family and friendships, or in their performance at school or work). Depending on the main focus of the fear and/or concern, we refer to one disorder or another.
- Separation anxiety disorder. In this type of disorder the child has an intense fear of being separated from the people who care for him for fear that something will happen to them and he will not see them again. For example, when a child gets nervous every time their mother leaves home, even if they stay with their father. They might start crying and screaming and say that something bad might happen to their mother in the street or that she might have an accident. Even so, the child might accept going to school, but must be taken out of the school canteen, and the child’s parents must be very punctual when picking them up at the end of school. Only hearing about the school’s community is enough to make the child cry.
- Specific phobia. This is when a person has an intense fear of an object or situation (for example, injections, airplanes, heights, insects, etc.) or has a social anxiety disorder (or social phobia) when fear occurs in social situations (for example, having a conversation, being observed or having to perform in front of other people, etc.). A specific phobia might be, for example, when a person is afraid of heights and gets very nervous, trembles, and feels dizzy when confronted with a height. A case of social anxiety disorder would be when a person feels very nervous when talking to other people. They become afraid of doing something that makes them look ridiculous, leading others to think negative things about them. In these situations, the person usually turns red, and when they realize they have had this reaction, they feel even worse.
- Panic disorder. A panic attack is defined as an episode of sudden and intense anxiety accompanied by unpleasant physical feelings (for example, palpitations, drowsiness, dizziness, etc.) and thoughts that are usually catastrophic (for example, fear of losing control or dying, among others). Panic disorder often occurs in conjunction with agoraphobia. It would be the case of a person who feels discomfort and anxiety in situations where he thinks he might faint, when he goes on the subway, the bus, in downtown streets, with many people forcing him not to take public transport and need to always be accompanied.
- Agoraphobia. The person is usually afraid and has feelings of anxiety (for example, their heart beats fast or they sweat a lot) when in certain situations, in case they cannot leave or ask for help if they need it. As a result, the person usually avoids situations such as taking public transport or going to a concert or a restaurant. For example, a person who is very uncomfortable and anxious because they think they may become faint when they get on a train or a bus, forcing them to get off before they reach their destination. In the end, this person chooses not to take public transport. They might have a similar feeling when they go shopping or when in a city where there are crowds of people.
- Generalized anxiety disorder. When a person worries all the time about several day‑to‑day things (for example, about school, work, or for their children’s health), to the point that these concerns affect their sleep or ability to concentrate, or the person feels very tense or fatigued. For example, a person who is a long‑term worrier who, in their childhood was concerned about whether their parents had enough money or if they would die, and since starting compulsory secondary education, their worries have increased. Above all, they worry about passing their exams and abandonment by their friends if they say something they do not like. All this makes it difficult for the person to sleep and means that they are constantly in tension. It also usually means that they have days when their head hurts and they get stomachaches.
The same person may have several anxiety disorders at the same time, and it is not unusual for an individual to have other mental health disorders (such as depression or problems with the abuse of substances like alcohol).
How Anxiety works
When talking about how an anxiety disorder works it is useful to think of it as a vicious circle, that is, a self‑sustaining cycle that tends to stay in place and become stronger.
Broadly speaking, when a person has symptoms of anxiety, they notice some unpleasant physical sensations such as palpitations or dizziness. This happens because situations of danger (real or imaginary) produce reactions at the brain and hormonal level that activate the body like a fire alarm: when a possible threat is detected, the person’s entire attention is directed towards this situation so that they can escape the danger and survive.
Thus, the person breathes faster (to get more oxygen), their heart beats faster (to get more blood containing glucose and oxygen to their muscles and brain), their muscles tense up (so that they are more prepared to flee or defend themselves), and the pores of their skin close (to protect it from possible injuries), etc. In parallel, information from the body’s alarm system is sent to other glands in the body to release more hormones (glucocorticoids) that have an anti‑inflammatory effect on tissues and organs, to prevent physical damage. Thus, the body starts to feel like a pressure cooker.
Once the danger has passed, if the person is successful in dealing with the threat, or if they simply realize that there is no real threat, the alarms in their brain are deactivated, the nervous system is rebalanced, and the sense of fear or anxiety decreases.
However, sometimes, the person does not know what the specific danger is or where it comes from. This causes their attention to focus on unpleasant bodily sensations, which usually makes their heart and breathing rate further increase to a point where it is difficult for them to breathe. The increase in these feelings also increases the person’s negative thoughts. If all this happens when, for example, that person is in an elevator, it is likely that at some point they will decide not to use elevators anymore (avoidance) or only to take new elevators or when accompanied by friends or family (safety behavior).
This example shows how avoidance and the use of safety behaviors (‘tricks’ people use to deal with the situations they fear) in fact help to maintain the disorder, because they do not allow the person to see that their negative thoughts (“the elevator will break down and I will have trouble breathing”) are incorrect, and so the individual may think that they have been ‘saved’ thanks to their avoidance or safety behaviors.
In certain people, especially if they have been subjected to intense periods of emotional overload and threats during certain periods of their development or if they are vulnerable to anxiety, responses of fear/anxiety may continuously appear because their brain circuits responsible for alerts become hypersensitive or become very slow at restoring balance once threats have disappeared. In addition, the repetition of avoidance responses can also affect the normal functioning of the person’s daily life and diminish their freedom and autonomy. This is when anxiety and fear become pathological and become a disorder. In addition, the frequent activation of the hormonal structures involved can be harmful to the body itself, because the continuous presence of glucocorticoids in the blood can affect other tissues and viscera in the body and generate physical disorders, discomfort, or pain in different systems, as well as depression or fatigue.
How many people do Anxiety Disorders affect?
Anxiety disorders are one of the most frequent groups of mental disorders. Figures vary depending on the parameters considered, but there is some consensus that 1 in 5 people will have an anxiety disorder during their lifetime. In the case of children and adolescents, this figure is around 6 out of every 100.
The number of people affected also varies depending on the disorder, for example, specific phobias are the most frequent of all the types of anxiety disorder.
Women are usually thought to be at a greater risk than men of suffering an anxiety disorder, but the figures do vary depending on the disorder in question and the age group considered. For example, the presence of social anxiety disorder is more equal between men and women, and the difference between the sexes is not as marked in children and adolescents as it is in adulthood.
Several studies have indicated that anxiety disorders that remain untreated are likely to become more chronic and that the people suffering them are more at risk of developing other psychiatric disorders such as depression or excessive consumption of toxic substances. Experiencing chronic anxiety can affect the functioning of other body systems and increase the risk of having medical illnesses (such as gastrointestinal disorders or heart problems, among others).