"When Does Worry Become Anxiety?" Understanding Anxiety Disorders

Everyone worries. We worry about our children, our health, our jobs, our finances and what other people think of us. Before an important meeting, examination or unfamiliar situation, feeling anxious is a completely normal human response.

This can sometimes make it difficult to know when anxiety has become something more than ordinary worry.

People often come to see me after living with anxiety for a long time because they assumed that everyone felt the same way. Others recognise that they are struggling but tell themselves that they should simply be able to control their thoughts.

The difference between everyday anxiety and an anxiety disorder is not simply how much somebody worries. What matters is how persistent the anxiety has become, how difficult it is to manage and how much it is beginning to affect everyday life.

Anxiety Has a Purpose

Although anxiety can feel unpleasant, it is not inherently a bad thing.

Our brains have evolved to recognise possible threats and prepare us to respond to them. When we sense danger, our heart may beat faster, our breathing changes and our attention becomes focused on what is happening around us. This response can be extremely useful when there is a genuine threat.

The difficulty comes when this alarm system becomes active in situations that are not actually dangerous or remains switched on long after the threat has passed.

Someone may understand logically that there is nothing to fear while their body and mind continue responding as though there is.

That is one reason why telling somebody with anxiety to "stop worrying" rarely helps.

Anxiety Isn't Always About Worry

When people think about anxiety, they often imagine someone sitting and worrying about something.

In reality, anxiety can present in many different ways.

Some people experience constant thoughts about things that might go wrong. Others experience physical symptoms such as a racing heart, sweating, shaking, dizziness, nausea or shortness of breath. Some experience sudden episodes of intense fear that seem to appear without warning.

Anxiety can also affect concentration, sleep and decision-making. People may become irritable or find themselves constantly seeking reassurance from those around them.

Sometimes the most noticeable sign of anxiety isn't how somebody feels.

It is what they have stopped doing.

The Avoidance Trap

Avoidance is one of the most understandable responses to anxiety.

If travelling on a train makes you anxious, avoiding trains immediately makes you feel better. If social situations make you uncomfortable, cancelling an event removes that discomfort. If you are frightened of making a mistake, putting off the task means you don't have to face that possibility.

In the short term, avoidance works remarkably well.

Unfortunately, this can also teach the brain that the situation really was dangerous and that avoiding it was what kept you safe.

Gradually, the list of things being avoided can grow.

Someone who initially avoided one particularly busy train may eventually stop using public transport altogether. Someone who felt anxious at a large party may begin declining smaller social events as well.

Before long, anxiety can begin making decisions on the person's behalf.

Anxiety Disorders Don't All Look the Same

There are several different anxiety disorders and the experience can vary considerably between individuals.

Generalised anxiety disorder tends to involve persistent and excessive worry across several areas of life. Panic disorder involves recurrent panic attacks and often a fear of experiencing another one. Social anxiety involves significant anxiety about social situations and being judged or embarrassed by other people. Phobias involve an intense fear of a particular object or situation.

There are also conditions such as obsessive compulsive disorder and post-traumatic stress disorder which can involve significant anxiety but have their own distinct features.

This is why understanding the nature of someone's anxiety is important before deciding how best to treat it.

Why Can't I Just Think My Way Out of It?

This is something people frequently find frustrating.

They know the aeroplane is unlikely to crash.

They know other people probably aren't judging them.

They know the physical sensations of a panic attack are likely to pass.

Yet the anxiety remains.

The reason is that anxiety is not simply a logical belief that can be corrected by knowing the facts. It involves emotional, physical and behavioural responses as well.

You can understand intellectually that something is safe while still feeling frightened by it.

Treatment therefore often involves helping the brain learn through experience that situations can be tolerated rather than simply repeatedly telling yourself that everything will be fine.

Anxiety Is Treatable

The encouraging thing about anxiety disorders is that effective treatments are available.

Psychological therapies can be particularly helpful. Cognitive behavioural therapy, or CBT, can help people understand the relationship between their thoughts, feelings and behaviours while gradually changing patterns that may be maintaining anxiety.

Depending on the nature and severity of the difficulties, medication can also have an important role.

Lifestyle factors such as sleep, exercise, alcohol and caffeine can influence anxiety as well, although these should usually be considered alongside appropriate treatment rather than presented as a substitute for it.

The right approach will depend on the individual, their particular symptoms and how significantly anxiety is affecting their life.

A Final Thought

Perhaps the most important thing to understand about anxiety is that the goal is not to eliminate anxiety altogether.

None of us would want that.

A certain amount of anxiety helps us recognise danger, prepare for important events and respond appropriately when something matters to us.

The problem begins when anxiety stops protecting us and starts restricting us.

If worry is occupying large parts of your day, if fear is regularly determining what you can and cannot do or if anxiety is affecting your relationships, work, education or enjoyment of life, it may be worth seeking help.

You do not need to wait until anxiety has taken over your life before doing something about it.

Sometimes recognising that what you are experiencing has moved beyond ordinary worry is the first step towards taking back some of the control that anxiety has gradually taken away.

Dr James Glass
MBChB MRCPsych
Medical Director, WMI Psychiatry