Anxiety is a natural human feeling to prepare us for a potential problem. Anxiety is the feeling you get when you are prepared for action, but don’t know what that action is – this is natural and not a problem when it is occasional. If Anxiety becomes a common feeling then something is wrong and you may have an Anxiety Disorder. Anxiety disorders are most commonly a biological cause, generally neurological and sometimes related to other biological systems such as cardiopulmonary (heart and lungs) or hormones. In rare circumstances, Anxiety may be related to a traumatic experience which has led to maladaptive over-preparedness.

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. The biological process of anxiety quickens your reflexes and keeps you alert for change.

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, Fawn, 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.

Fear Response Versus an Anxiety Response

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.

If, for example, you are responding to a simple fear problem, like a wild animal, then Freeze, Fawn, 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.

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.

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.

Ongoing Anxiety – Symptom versus Disorder

Medicine used to diagnose people as having “Fever”, not as a symptom, but as a cause. They would try to treat fever by putting people in ice baths and codl cloths to try to get the fever down. This is important, as becoming too hot can cause bad biological consequences (including death), but the treating the reason for the fever is more important. Once we knew what caused fevers, Fever became a symptom.

In my opinion, ongoing Anxiety should be considered a symptoms. Yes, you have the persistent feeling of anxiousness without a clear threat or uncertainty to be anxious aboiut – what is causing that symptom?

At this stage, Anxiety Disorder is considered to be a diagnosis of a thing, not a symptom of another. In my practice, we acknowledge that you have been diagnosed with Anxiety, but then we try to work out why you have this symptom.

Anxiety Disorder is Rarely Caused by Trauma – but it can be…

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

Here we will briefly visit a few different types of Anxiety Disorder

• How to tell if this is what you are experiencing
• Treatment options
• If this is a clue to check for other things

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. It is the feeling of being ready for instant action and expecting something to go horribly wrong at any moment with disasterous consequences.

Importantly, the feeling of Anxiety is moslty independent of the location and not due to the presence or absense of people (although it may peak in some places, circumstances and with some people). If this level of Anxiety is a core component of your decisions to, or not to, do tasks, then GAD may be a correct diagnosis for you.

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 (rejection sensitivity / people pleasing).

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

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.

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

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. The stress feels like Anxiety.

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, significant 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 / misgendered. 

PTSD is generally diagnosed after a person has had a reasonable time to process an adverse 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, but enough of them do. It is not PTSD if you had these symptoms prior to your event, even if the event made them worse (this isn’t as black and white as I have simplified it here).

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 (as in, ignoring that symptoms pre-exist a discovered traumatic event). 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, leading to a misdiagnosis and thus the wrong treatment plan / treatment focus.

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

TLDR: When Anxiety is focused on a single or a limited few triggers, it may be a Phobic response, not 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.