Anxiety is a natural human feeling to prepare us for a potential problem. When it becomes a common feeling, something is wrong, which might be a disorder.

Understanding Anxiety

Feeling Occasionally Anxious is Normal

Anxiety is a feeling of worry, nervousness, or unease about something with an uncertain outcome. At low levels it prepares us for an experience with low predictability in case the outcome is not good for us and we need to act quickly and decisively to become safe.

This is a good thing.

Anxiety heightens our perception of change and harm so that we can better prepare for emergency action. That action is usually driven via the Fear reflex – Freeze, Faun, Flight and Fight. While prepared, not only are our senses sharpened, it also improves focus and your reflexes. Mostly this is driven by biology, specifically Adrenaline.

Anxiety is supposed to be short term, and give us a clear idea about what we need to be cautious about, even if you can’t see it. Anxiety is generally about known situations that should pass.

Ongoing anxiety keeps you at a level of alertness all of the time. It drives hyper vigilance, hyper reactivity and can cause misperception of the circumstances, leading to poor decisions. At higher levels, anxiety can incapacitate one’s quality of life, as the anxious person is frequently enacting the freeze and flight fear response, and less commonly the fight fear response.

A Fear Response Versus an Anxiety Response

If you are responding to a simple fear problem, like a wild animal, then freeze, faun, flight and fight are excellent responses. These often don’t work as well with modern civilisation, where it is rare that you need to fight off animals or act in an emergency situation. In modern civilisation you need a more nuanced and subtle solution to life’s dramas.

The difference between a fear response and an anxiety response is that with fear, the threat really is there and the consequences are that bad. An anxiety response is in the absence of a tangible threat, after the tangible threat has passed, or the response is in excess of the threat.

When Anxious Becomes an Anxiety Disorder

It is natural to feel anxious when there is clear and present danger such as a dangerous wild animal, or when you anticipate risk, such as just prior to giving an important presentation. If, however, you feel anxious in the absence of these present or near future triggers, your anxiety is not considered typical.

To make sure that we are not pathologising a natural part of being human, we can feel extended anxiety:

• Prior an expected event: if there is a big thing coming, such as a large scale performance, or working towards a promotion, then it can be normal to feel some level of anxiety for a few weeks.
• Post an unexpected event: If you have experienced a big event, such as losing your job, a very nasty fight or a car accident, it is normal to feel a level of anxiety for a few weeks after the incident.
• During ongoing threat: such as threat of being fired, being with an abusive partner etc for as long as that threat is still able to affect you.

If you are feeling anxious most of the time in the absence of the above kinds of triggers, there may be an Anxiety Disorder involved. The word “Disorder” is a medical term we use to describe when something has got in the way of living your life. If your Anxiety is shaping who you are and how you respond to the world in a general sense, then likely an Anxiety Disorder is what we are looking at.

There are many different types of Anxiety Disorder. We are going to take a whirlwind tour of a few different types of anxiety disorder. Some of these quick looks expand out to more in-depth pages.

TL:DR, Anxious is temporary, anxiety is long, anxiety disorder is mostly always present to always present.

Anxiety Disorder is Rarely Trauma… but it can be

An Anxiety Disorder is most often due to biology:

• Mostly chemistry issues, most typically neurological, or dietary issues
• Sometimes secondary to cardiovascular
• Sometimes secondary to breathing difficulties.
• Rarely other biology health causes, but there are others.

The least common kind of Anxiety Disorder is due to Trauma. We have a section about Trauma, the truth, the myth and the misattribution.

In short, humans evolved to be good at recovering from bad experiences, including what most people call Trauma. Most often, a traumatic experience exposes the underlying Anxiety Disorder as the experience either does some damage to our self management system, or allows us to admit to how bad our Anxiety is. It is also important to recognise that sometimes a Trauma can create an Anxiety / Adrenaline problem, which is generally called PTSD.

Anxiety Disorders

General Anxiety Disorder (GAD)

GAD describes how you can feel anxious in most places – whether it be the privacy of your own home, safely in your own room; or at work/school; or at a peaceful park. Importantly, the feeling of anxiety is independent of the location, although it may peak in some places and circumstances. If this level of anxiety is a core component of your decisions to, or not to, do tasks, you likely have GAD.

Treatments:

• Medication
  • Frequently SSRI medication (Selective Serotonin Reuptake Inhibitors)
  • Frequently Alpha Blockers (adrenaline), such as Clonidine (Catapres)
• Talking Therapy
  • Most frequently CBT
    • Build better interoception (ability to look at your own response)
    • Build strategies to calm and self sooth
    • Shift philosophies about the world to shift your expectations of disaster, and build self-confidence that you can manage things

Social Anxiety

Social Anxiety describes how you can feel anxious in the presence of strangers, acquaintances, friends and family. While not all people will necessarily trigger anxiety for you, the feelings of anxiety diminish when you are alone and not thinking about other people’s judgments, reactions or negative experiences.

In essence, in the absence of others, anxiety is significantly reduced. 

Social Anxiety is usually a side effect of some other category of problem and is commonly found with Autism, ADHD, or PTSD.

Treatments:

• Medication
  • Sometimes SSRI medication
  • Frequently SNRI medication, mostly Desvenlafaxine (Pristiq)
  • Frequently Alpha Blockers (adrenaline), such as Clonidine (Catapres)
  • For ADHDers, amphetamine or methylphenidate often helps, often in combination with either Desvenlafaxine (30% of ADHDers) or Clonidine (10% of ADHDers)
• Talking Therapies
  • CBT, general anxiety strategies as above for GAD
  • DBT, specific strategies for interpersonal and self management
  • DV, if you are in a Domestic Violent or other abusive relationship

OCD, a cousin of Anxiety

OCD stands for Obsessive Compulsive Disorder. Many people mistake OCD for other psychological traits such as Autism. Let us debunk a few of those. See our OCD page for more details.

OCD is a combination of Obsessive and Compulsive traits that are either beyond the control of the individual or very difficult to resist. Here, obsessive describes a thought or idea that seems to intrude upon the person’s mind and seems like it comes from elsewhere. It is not a pleasant thought or idea; and compulsive describes actions or rituals taken that are repetitive and perceived to prevent an unlikely or disconnected event, generally of a catastrophic nature. As mentioned before, it is a disorder because the thought intrusion and the requirement to do the action interfere in one’s life.

I have included OCD here because of the anxiety component involved. The person will feel very anxious about the future catastrophe and extreme anxiety and fear in the absence of doing the ritual that staves it off, or if the ritual is incomplete or no longer effective.

Most OCD has a neurological component and some medications are quite effective at relieving the symptoms. 

Generally a combination of talking therapies to address the perception of fear and find non-ritualistic methods to self sooth combined with pharmacological treatment are the best solution.

PTSD, Trauma based Anxiety

PTSD stands for Post Traumatic Stress Disorder. It is one of the best initialisms in the psychiatric part of medicine as it literally tells you what it is in plain language. This is the Stress one feels after a traumatic situation, where that stress has reached the level of a disorder – that is, it interferes with your quality of life.

One person’s bad experience can be another person’s trauma, and that other person’s bad day can be the first person’s trauma. What I am trying to say here is that trauma is personal. Most of us would agree on some common themes of what should be a traumatic experience for most people, such as war, death, pain etc; but not everyone will agree on uncommon themes, such as a long term adversarial experience with a parent, or workplace bullying, or being misnamed. 

PTSD is generally diagnosed after a person has had a reasonable time to process an experience and adjust, but hasn’t. PTSD is characterised by flashbacks, difficulties sleeping, avoidance of certain stimuli related to the traumatic event, decline in mood, hypervigilance, disassociation and a number of other traits. Not all of these need to be present in the person’s post trauma stress. 

I have included PTSD here as a common aspect of the condition is anxiety about when symptoms are going to occur, anxiety regarding a recurrence of the traumatic event and the avoidance of certain stimuli. 

PTSD can be exaggerated by untreated and undiagnosed ADHD, various Personality Disorders and/or anxiety disorder. Sometimes a traumatic event can exaggerate the symptoms of these and be mistaken for PTSD. For those who are assessing, it is important to do a careful investigation of when traits first appeared and not stop looking when a traumatic event has been identified. In my experience, it is not uncommon that behaviours and traits pre-date the traumatic event, and the traumatic experience has dysregulated a management method.

Treating PTSD requires talking therapy and is frequently supported by medications, especially if there is a background condition identified that was not previously being treated.

Phobia, a cousin of Anxiety

Phobia comes from the greek root word Phobos, meaning “fear” and is used to refer to an avoidance or running away from that which we irrationally fear. Most people have a thing that they are more uncomfortable around than most, and when that level of discomfort drives the individual to an action or makes other actions near the object of fear difficult, the discomfort is considered to have become a phobia. Generally there is little to no logic behind the source of fear. There are long lists of things that people irrationally fear and we are not going to list them.

Earlier I outlined that anxiety is a fear response to thing that is not present, but is anticipated to cause potential harm, and that an anxiety disorder is where that anxiety is either persistent, or disproportional to the event or object.

With phobia, the anxiety is disproportionate to the object that inspired fear. The person with the phobia will frequently try to justify their fear of the thing so that it seems reasonable and rational. However if no one else (or very few) fears it, even when comprehending it, then the likelihood is that the fear is disproportionate or misattributed to a thing that does not deserve it.

Sometimes the fear is secondary to a disgust reflex, where the individual has learned at some level that “that is wrong” and is thus disgusted in the presence or thought of the thing. This disgust is hard to reconcile, so the feeling is quickly changed to fear. This fear can then be hard to socially demonstrate, and so it is then transformed into anger. When we append the word “phobe” to the end of a noun describing a particular group of people, we are often referring to people that are aggressive about that group. When we look at the source of that anger, it is fear, and when we look at the source of that fear, it is disgust. This disgust is irrational and hard for someone to reconcile.

Phobias and phobes can be managed via talking therapies, which will frequently use various forms of exposure therapy after upskilling the person to manage their mood around the source of fear, and upskilling the person’s mind frame about the thing. This may include some careful use of sedatives to decrease the feelings of anxiety such that the lack of consequence from the thing is observed and internalised. Because the phobia is often based on a fundamental illogical disgust reflex, refreshers of exposure may be needed for many years.

It is important to note the difference between a phobic response to a stimulus and a pain response to a stimulus, such as what Autistic people experience. You can desensitise from the fear / aggressive response to a thing, but you cannot desensitise from a pain reaction to stimulus (such as loud noises). That pain response can trigger aggression and avoidance, and can easily be mistaken for anxiety or phobia. This pain response requires a different method of management, which may include some of the same tools as noted before – reframing and exposure, but will often implement sensory aids such as earphones, gloves and tinted glasses, depending on the source of the sensory overload.