What is Anxiety? A Summary

Anxiety refers to a group of disorders that are collectively the most common mental health condition in Australia (Black Dog Institute 2018).

As per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), anxiety is separated into two categories:

• Anxiety disorders (generalised anxiety disorder, panic disorder, specific phobia, agoraphobia, social anxiety disorder, separation anxiety disorder); and
• Obsessive-compulsive disorder (related to body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder).

(American Psychiatric Association 2013)

What is Anxiety?

Anxiety is an evolutionary safety mechanism that exists to keep humans safe from harm or danger by triggering the ‘fight or flight’ response (Black Dog Institute 2018).

It activates in response to a stressor, causing psychological and physical changes within the body so that the individual can confront the situation (Harvard Medical School 2018).

Every person experiences anxiety during their life - it is normal and often helpful. However, in some cases, anxiety is unnecessarily constant and overwhelming, interfering with a person’s ability to go about their daily lives. This could indicate an anxiety disorder (HelpGuide 2019; Healthdirect 2018).

Anxiety disorders may disrupt several aspects of a person’s life, including their ability to concentrate, sleep or perform daily tasks. It may also cause an individual to avoid certain situations or leaving the house. In some cases, it can cause physical symptoms such as shortness of breath, a pounding heart or trembling hands (Healthdirect 2018).

Types of Anxiety Disorders

According to the American Psychiatric Association (2017), anxiety disorders include:

• Generalised anxiety disorder: An intense and constant worry that interferes with daily activities;
• Panic disorder: A person experiences frequent panic attacks (sudden feelings of overwhelming and intense fear and distress);
Specific phobia: An intense and irrational fear towards a specific object or situation;
• Agoraphobia: A fear of being in a situation where the individual is not able to easily escape;
• Social anxiety phobia: Severe anxiety and fear relating to social situations;
• Separation anxiety disorder: A persistent and inappropriate fear of being separated from people the individual is attached to; and
• Obsessive-compulsive disorder (OCD): A person experiences recurring obsessions (thoughts or images that cause anxiety) and feels an overwhelming need to perform compulsions (rituals or behaviours) in order to alleviate the obsessions.

(American Psychiatric Association 2017; Black Dog Institute 2018; Better Health Channel 2018)

Prevalence

The ABS National Survey of Mental Health and Wellbeing in 2007 estimated that about one in four people (one in three women and one in five men) will experience an anxiety disorder at some stage of their lives.

Furthermore, about two million Australians will experience anxiety during a single 12 month period (ABS, cited in Beyond Blue n.d.).

Causes of Anxiety

Anxiety disorders can be caused by a variety of factors. It is thought that some people are born with a genetic predisposition to develop anxiety. Other factors may include personality traits and stressful life events such as:

• Unpredictable new situations (e.g. changing school or job, travel);
• Relationship break-ups;
• Death of someone close;
• Financial or work problems;
• Early childhood experiences;
• Excessive use of drugs or alcohol; and
• Physical health problems.

(SANE 2018)

Signs and Symptoms of Anxiety

The symptoms of each specific anxiety disorder are set out in the DSM-5, each with individual diagnostic criteria that should be met.

In a more general sense, there are some common symptoms that will often apply to anxiety disorders:

Psychological Symptoms

• Excessive feelings of worry and dread about what might happen in the future;
• Persistent worry and thoughts about events from the past;
• Obsessive thoughts that are difficult to stop; and
• Fear and panic in situations where there is no danger.

(SANE 2018)

Psychical Symptoms

Physical symptoms are responses to fight or flight mode that would occur in the case of real danger (SANE 2018). They include:

• Faster breathing;
• Muscle tension;
• Trembling and sweating;
• Headaches;
• Nausea or stomach problems;
• Teeth-grinding;
• Fatigue;
• Restlessness; and
• Difficulty sleeping.

SANE 2018)

Behavioural Symptoms

• Avoidance of certain situations that may cause anxiety.

(Beyond Blue n.d.)

Anxiety Diagnosis

According to the DSM-5, the following criteria should be met in order to diagnose a generalised anxiety disorder:

• Excessive anxiety and worry that occurs more days than not, for at least six months.
• The individual finds it difficult to control this anxiety.
• The anxiety is associated with at least three of the following symptoms:
  • Restlessness;
  • Easily becoming fatigued;
  • Difficulty concentrating;
  • Irritability;
  • Muscle tension; and
  • Sleep disturbance.
• The anxiety causes distress or impairment in important areas of functioning.
• The anxiety is not related to a substance or another medical condition.
• The anxiety is not better explained by another medical disorder.

(American Psychiatric Association, cited in Reynolds & Kamphaus 2015)

According to the DSM-5, the following criteria should be met in order to diagnose an obsessive-compulsive disorder:

A. There is a presence of obsessions, compulsions or both:

• Obsessions:
  • Recurrent and persistent thoughts, urges or impulses that are intrusive, unwanted and cause distress; and
  • The individual attempts to ignore or suppress or neutralise these thoughts.
• Compulsions:
  • Repetitive behaviours or mental acts performed in response to an obsession; and
  • These repetitive behaviours aim to reduce anxiety or prevent a specific situation but are not connected to that anxiety or event in a realistic way, or are excessive.

B. The obsessions or compulsions are time-consuming or impair important areas of functioning.

C. The symptoms are not related to a substance or another medical condition.

D. The anxiety is not better explained by another medical disorder.

(American Psychiatric Association, cited in Rockville 2016)

[Refer to the APA's DSM-5 for the full list of diagnostic criteria for anxiety disorders.]

Anxiety Treatment and Management

There is a range of effective treatments for anxiety. Treatment generally falls within three categories:

1. Psychological treatments including cognitive-behavioural therapy (CBT), exposure therapy, mindfulness therapy, counselling etc.
2. Medication.
3. Self-help (e.g. exercise, meditation, relaxation techniques, yoga etc.)

(Black Dog Institute 2018)

Treatment may differ depending on the kind of anxiety disorder a person is experiencing and may involve a combination of the above strategies. It is important to consult a health professional in order to determine the appropriate kind of treatment for each individual (Black Dog Institute 2018).

Anxiety is treatable and can be managed so that its impact on your life lessens significantly. In some cases, it can be eliminated entirely (SANE 2018).

If you’re in crisis and need support, call Lifeline on 13 11 14. Lifeline is open 24 hours a day, 7 days a week.

• Beyond Blue, https://www.beyondblue.org.au/
• SANE, ttps://www.sane.org/
• Black Dog Institute, https://www.blackdoginstitute.org.au/
• Find a Psychologist, Australian Psychological Society, https://www.psychology.org.au/Find-a-Psychologist
• Who Can Assist? Beyond Blue, https://www.beyondblue.org.au/get-support/who-can-assist
• Understanding Anxiety, https://www.ausmed.com.au/cpd/lecture/understanding-anxiety

References

• American Psychiatric Association 2017, What Are Anxiety Disorders?, American Psychiatric Association, viewed 17 March 2020, https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
• American Psychiatric Association 2017, What is Obsessive-Compulsive Disorder?, American Psychiatric Association, viewed 17 March 2020, https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder
• Better Health Channel 2018, Agoraphobia, Better Health Channel, viewed 13 March 2020, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/agoraphobia
• Beyond Blue 2020, Anxiety, Beyond Blue, viewed 13 March 2020, https://www.beyondblue.org.au/the-facts/anxiety
• Beyond Blue 2020, Statistics, Beyond Blue, viewed 17 March 2020, https://docs.google.com/document/d/1HllseIEnzKG5GBvWtvlMrWtEmxVrJw_Hz-ax4_eCZlY/edit
• Black Dog Institute 2018, Treatments for Anxiety, Black Dog Institute, viewed 16 March, https://www.blackdoginstitute.org.au/clinical-resources/anxiety/treatment
• Black Dog Institute 2018, What is Anxiety?, Black Dog Institute, viewed 13 March 2020, https://www.blackdoginstitute.org.au/clinical-resources/anxiety/what-is-anxiety
• Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA, American Psychiatric Association 2013.
• Harvard Medical School 2018, Anxiety and Physical Illness, Harvard Medical School, viewed 13 March 2020, https://www.health.harvard.edu/staying-healthy/anxiety_and_physical_illness
• Healthdirect 2018, Anxiety - an Overview, Healthdirect, viewed 13 March 2020, https://www.healthdirect.gov.au/anxiety
• HelpGuide 2019, Anxiety Disorders and Anxiety Attacks, HelpGuide, viewed 13 March 2020, https://www.helpguide.org/articles/anxiety/anxiety-disorders-and-anxiety-attacks.htm
• Reynolds, C & Kamphaus, R 2015, The Behavior Assessment System for Children, 3rd edition, Pearson, viewed 16 March 2020, https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_GeneralizedAnxietyDisorder.pdf
• Rockville 2016, Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, viewed 16 March 2020, https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t13/
• SNE 2018, Understanding Anxiety Disorders, SANE 2018, viewed 13 March 2020, https://www.sane.org/information-stories/facts-and-guides/anxiety-disorder#understanding-anxiety-disorders

(Answers: a, c, a)