Do You Have Everyday Anxiety or an Anxiety Disorder?
Feeling nervous about meeting a new group of people? On edge before an important deadline? That’s anxiety. Though it can be uncomfortable, it’s a perfectly healthy (and pretty much unavoidable) experience. But if it starts to disrupt your life, then you may be dealing with something beyond run-of-the-mill unease—an anxiety disorder.
Anxiety disorders are the most common mental health conditions in the United States. Approximately 33.7 percent of the population is affected by an anxiety disorder at some point in their lifetime and, research suggests, that number is likely to tick up as younger generations report higher and higher rates of the condition.
Women tend to bear the bigger burden: Between adolescence and age 50, women are twice as likely as men to have an anxiety disorder.
But you don’t have to simply power through, thinking “good vibes only” and hoping for the best: There are a number of effective treatments available. An anxiety disorder doesn’t have to rule your life.
How’s an Anxiety Disorder Different From Everyday Anxiety?
First, know that anxiety is not just normal, but serves an important purpose, says Margaret Distler, M.D., Ph.D., a psychiatrist at UCLA Anxiety Disorders Clinic in Los Angeles. “It helps us identify potential threats in our environment to keep ourselves safe.”
Physiologically, it initiates the fight-or-flight response. “Increased heart rate, fast breathing, sweating, chest tightness—all of those things were evolutionarily designed to help protect us in the face of danger,” Dr. Distler explains. Running from a bear is a classic example. A more modern one? The distress you might feel at eyeing your 157 unread email messages.
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Cognitively, anxiety also triggers important processes that work a bit like internal HR: vigilance, which helps us assess situations, and planning, which enables us to take action. So, if you’re working on a big project, a healthy dose of anxiety can actually help you anticipate and avoid pitfalls.
Anxiety morphs into a disorder when that physiological response pops up a little too often, a little too intensely, or both. To distinguish between everyday anxiety and an anxiety disorder, a mental health expert may ask three questions.
Question #1: Is your anxiety out of proportion to the threat?
If there’s no real threat or you perceive the threat to be much bigger than it really is, that may be an indication of disordered anxiety, Dr. Distler says.
For example, people who are deeply afraid of flying tend to overestimate the risk of getting into a fatal plane crash. In reality, your risk of dying on a scheduled commercial flight is much lower than your risk of dying in a passenger vehicle, bus, or train in the United States, according to the National Safety Council. In fact, the passenger vehicle death rate is 1,623 times higher than the rate for commercial flights.
Question #2: Is anxiety prolonged?
Anytime you’re in a new or stressful situation, it’s normal to feel anxious. But if the anxiety persists even when the stressor is gone, that may be a red flag. “Usually, we look at a time frame of one to six months to see if someone’s anxiety response is excessive,” Dr. Distler explains.
Question #3: Is anxiety interfering with your life?
This is the most important, illuminating question.
“A typical anxious response is usually adaptive, which means that maybe it’s not a pleasant experience, but someone’s able to utilize those emotions to navigate a difficult situation,” Dr. Distler says.
“But in an anxiety disorder, the anxiety starts to take away from someone’s life,” she adds. “It becomes a hindrance in the ability to make it through the day. Or it gets in the way of the ability to go to school or work, interact with loved ones, or take care of yourself. All of those things are indicators of functional impairment.”
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Common Symptoms of an Anxiety Disorder
The tricky thing about anxiety disorders is that symptoms can be wide-ranging, possibly affecting how you think, behave, and feel, emotionally or physically. You may have some symptoms but not all of them, or you you may mistake your symptoms for something else. Here are a few to know.
Hypervigilance and Excessive Planning
Remember the internal HR team you’ve got, vigilance and planning? While they’re part of normal anxiety, too much of either may signal an anxiety disorder. “Hypervigilance means hyperawareness—when someone is always on the lookout for signs that something could be wrong,” Dr. Distler says. “And if somebody has fears about negative outcomes—my boss is going to fire me, my spouse is going to be angry with me, my loved one is going to die in a car accident—they may plan excessively to avoid worst-case scenarios.”
Avoidance
A hallmark symptom of phobia, social anxiety disorder, and panic disorder is avoiding the feared object, Dr. Distler says. Think: going out of your way so you don’t have to drive over bridges, skipping out on dinner parties, or even limiting exercise because you’re afraid it’ll make your heart race, which can feel like a panic attack. Though avoidance can temporarily relieve anxiety, it reinforces the idea that the particular object is dangerous.
“Sometimes, people won’t volunteer for projects at work, for example, because they know they won’t be able to handle the anxiety it causes,” Dr. Nestadt explains.
Gut Issues
“People can be very surprised by how pronounced the physical symptoms of anxiety disorders can be,” says Melissa Shepard, M.D., a psychiatrist in Baltimore. “We’ll often see people with stomachaches, heartburn, vomiting, or diarrhea who got a full workup at another doctor, but nothing was found to be wrong. Then we’ll treat the anxiety, and the physical symptoms go away.”
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While scientists don’t fully understand the relationship between gastrointestinal problems and anxiety disorders, they know that the gut and brain communicate regularly through the body’s various signaling systems, and each can affect the other, according to a study in the Annals of Gastroenterology. For example, the gut can influence the balance of chemicals in the brain, and the brain can influence movement in the gut.
The gut-brain connection is so strong that digestive and mental health conditions often coexist. In one study, for example, 44 percent of people with irritable bowel syndrome (IBS) had an anxiety disorder, versus only 8 percent of people without IBS.
Pain, Fatigue, and Sleep Issues
In addition to GI distress, anxiety disorders can lead to other physical symptoms including muscle tension, headaches, neck pain, restlessness, sleep problems, and fatigue. One reason for this: With anxiety disorders, your autonomic nervous system is often out of balance. The part that controls the fight-or-flight response to perceived danger (sympathetic system) is essentially in overdrive. Meanwhile, its counterpart that manages the rest-and-digest response once the danger has passed (parasympathetic system) is inhibited. In other words, it can’t send the message, Hey, body, the threat is over—you can relax now. Instead, your body stays on high alert, and you may feel the effects of that.
Difficulty Concentrating
“It can be surprising how much anxiety can interfere with your brain’s ability to function, such as problems with concentration or memory,” Dr. Shepard says. Many people describe it as their “mind going blank.”
Though it’s a common symptom, the science behind it isn’t clear. In a group of 175 adults with generalized anxiety disorder (GAD)—characterized by excessive worry—almost 90 percent reported problems with concentration, and more severe concentration difficulties were associated with more severe GAD, according to a study in the Journal of Anxiety Disorders. The researchers theorized that worry makes it difficult to concentrate, which can interfere with daily tasks as well as lead to emotional distress.
Irritability
If someone you trust has commented that you seem more irritable lately, don’t dismiss it. Irritability is an underappreciated symptom of an anxiety disorder, Dr. Nestadt says. What gives? “When someone’s anxiety levels are very high, they may not have the emotional reserve to deal with much, so they might snap at people, get angry too easily, or just not have the tolerance for minor annoyances,” he explains.
The good news about anxiety disorders: They are one of the most treatable mental health conditions, says Debra Kissen, Ph.D., a psychologist and spokesperson for the Anxiety and Depression Association of America. “By taking action, there’s a lot to be hopeful for, even though it doesn’t feel like it in the moment when you’re struggling with anxiety.”
There are a variety of treatments for anxiety disorders, including therapy and medication options that can be used alone or together. “The research has shown that doing both therapy and medication in combination is more effective than just doing one or the other,” Dr. Shepard notes. “Medications help the brain to see things in a less-threatening way, but to have that actually mean something, you need experiences where you can look at things in a different way, and therapy pushes you to do that.”
If you feel like you’re suffering from excessive anxiety and worry, talk to a doctor or mental health professional.
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