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Before we tackle anxiety disorder, first we need to shed light on the basics of anxiety—the emotion. Worries and fears, the mainstay of anxiety, are an important survival function. But what is supposedly a normal and often healthy emotion can lead to isolation, irrational and uncontrollable fear, a sense of impending doom, shortness of breath or tightness in the throat— a full-blown medical disorder.
French cave paintings from the Paleolithic era, vividly depicting sources of fear, such as bears, lions, hyena, wolves, and rhinoceros might be the first known representations of anxiety.
Survival mechanism or anxiety disorder?
Anxiety is a protective mechanism meant to keep us out of danger. Our worries or fears are based on what we perceive as dangerous. Human minds were hard-wired to use fear, anxiety, and stress to help take action in the face of impending danger. We protect ourselves from threats by avoiding what we fear, but this becomes counterproductive if our perception of a threat is distorted.
In the face of danger, the brain releases the main stress hormone cortisol, responsible for the “fight or flight” response. This is an evolutionary adaptation that primes the body for dealing with threats. It causes increased heart rate, fast breathing, and increased blood flow towards the muscles. But it’s not just you, your cat’s cortisol level also rises in what it perceives as a dangerous situation, like seeing a cucumber for the first time. Ideally, when your furry friend is back to its comfy cat hammock sans the cucumber, its hormone levels should also go back to normal.
If the cat is exposed to repeated stress, it can develop anxiety due to the chronic increase of stress hormones in the body. Similarly, anxious people will do everything to stay away from their “stressors” (for example, a tiny spider)—even though these can’t possibly hurt or put them in danger—and ruminate on what other potential threats could occur.
Anxiety alerts us for disasters that never happen.
How much is too much?
One way to determine if a person’s anxiousness is pathological is to ask the questions: do their symptoms interfere with their ability to function properly? How much does it affect their work, school, and relationships? Anxiety has a physical, emotional, cognitive, and behavioral component. You don’t just think about fearful situations; you may sweat profusely or get butterflies in the stomach (nausea or indigestion). People with anxiety know that their thoughts are irrational but they are unable to control them. In return, they avoid the situation or endure the symptoms.
Before 1980, anxiety is a broad, undifferentiated, and non-specific condition that is often connected with other syndromes. The American Psychiatric Association’s 1980 DSM (Diagnostic and Statistical Manual) devoted 18 pages for anxiety disorders. In the recent fifth edition (2013), it now occupies ninety-nine pages. What’s the big deal? Based on the outdated DSM, only 4% Americans were diagnosed with anxiety disorder, but today, the number of patients increased to 18%, which means a large number of people suffering from anxiety in the past were not receiving treatments or probably did not know that they have anxiety. Simply because anxiety, like schizophrenia, was not regarded as an illness before the 19th century.
How anxiety is diagnosed
While anxiety can happen to anyone, not all anxious people will develop a psychiatric disorder. According to the APA, a person with an anxiety disorder is “having recurring intrusive thoughts or concerns.” Anxiety becomes a medical condition when it interferes with daily function. Physicians diagnose anxiety disorders by:
- doing a physical exam
- ordering blood or urine tests if a medical condition is suspected
- inquiring about your symptoms and medical history
- using the criteria from the APA DSM-5
- using psychological questionnaires
When people talk about anxiety disorder, they often mean generalized anxiety disorder—the most common form of anxiety. But there are other mental health disorders that feature anxiety as the main symptom. The DSM-5 grouped them in one category.
Common anxiety disorders and their symptoms
|Separation anxiety disorder||Excessive fear or distress concerning separation from the person or place to whom the individual is emotionally attached|
|Selective mutism||Inability to speak in certain social situations despite being able to speak in other situations.|
|Specific phobia||Excessive irrational fear of being exposed to a specific object or situations (fear of dogs, fear of flying, fear of heights, etc.)|
|Social anxiety disorder (Social phobia||Intense anxiety and fear experienced in interpersonal situations such as when performing in front of a crowd, attending parties or gatherings, making small talks|
|Panic disorder||Recurrent brief panic attacks accompanied by intense worry or behavioral change and physical symptoms such as chest pain, sweating, palpitation, nausea, chills, shortness of breath, fear of dying|
|Agoraphobia||Intense, irrational fear of being alone in places or situation where escape could be difficult or in which help would not be readily available in case of incapacitation|
|Generalized anxiety disorder||The most common anxiety disorder characterized by excessive and persistent anxiety or worry about common occurrences and situations|
Black, D., & Grant, J. (2014) DSM-5™ Guidebook The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders. Arlington, VA: American Psychiatric Publishing.
Crocq, M. A. (2015). A history of anxiety: from Hippocrates to DSM. Dialogues in clinical neuroscience, 17(3), 319–325.
Groenveld, E. (September 6, 2016) Lascaux Cave. Ancient History Encyclopedia. https://www.ancient.eu/Lascaux_Cave/
Horwitz, A. (2013) Anxiety: a short history. Baltimore: Johns Hopkins University Press
Johnston, J., & Bienvenue, J. (2014) Idiot’s Guide: Overcoming Anxiety. New York: Penguin Group Inc.
Mayo Clinic Staff (October 13, 2017) Generalized Anxiety Disorder. https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/diagnosis-treatment/drc-20361045