Everyone knows what it's like to feel anxious: the butterflies in your stomach before a first date, the tension in your shoulders when your boss criticizes you, or the way your heart pounds if you feel you're in danger. Anxiety is actually a warning signal for us. It can alert us to take action, especially if we're in threatening situations. It might make us study harder for exams or keep us on our toes when speaking in public. In general, it helps us to cope.
But what exactly is anxiety?
Anxiety is generally a feeling of uneasiness, apprehension, or tension that someone feels in response to stressful or threatening circumstances. Some people feel more anxiety than others. It can be mild or so intense that someone feels panic. Typically, anxiety is temporary. But when it lasts a long time or occurs at times when there is no stress or threat present, this normally helpful emotion can be considered a problem. No longer do you have just a case of the "nerves." You might have an illness that needs treatment and support.
Facts and statistics about anxiety
Here are some facts and statistics about anxiety:
- Anxiety illnesses are the most common emotional illnesses in the U.S.
- More than 18 million Americans are affected by anxiety illnesses.
- Anxiety illnesses cost the U.S. over $50 billion dollars to treat annually in the U.S. and are nearly one-third of the nation's total mental health bill.
Symptoms of anxiety
In general, there are both physical and psychological symptoms of anxiety. Psychological symptoms include:
- Difficulty concentrating
- Inability to relax
- Racing thoughts
- Trouble sleeping
Physical signs and symptoms include:
- Choking sensation
- Dry mouth
- Frequent urination
- Muscle tension
- Perspiration/warming of the skin
- Rapid or irregular heartbeat
- Shortness of breath
- Sweating, often in the palms
Types of anxiety illnesses
There are at least five general categories of anxiety and a sixth type of anxiety common for many college students: test anxiety.
"I always thought I was just a worrier. I'd feel keyed up and unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I'd worry about what I was going to fix for dinner, or what would be a great present for somebody. I just couldn't let something go."
Generalized anxiety is much more than the common anxiety people experience day to day. It's chronic and exaggerated worry and tension about everyday routine life events and activities that lasts for a period of at least 6 months, even though nothing seems to provoke it. People with generalized anxiety almost always anticipate the worst even though there is little reason to expect it. They can't seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation requires. They often worry excessively about money, health, family or work. Sometimes the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety.
Often people with generalized anxiety have difficulty relaxing or falling or staying asleep. They usually have physical symptoms such as trembling, muscle tension, headaches, irritability, sweating, frequent urination, hot flashes, or nausea. They may feel lightheaded, out of breath, or as though they have a lump in their throat.
"It started 10 years ago. I was sitting in a class and this thing came out of the clear blue. I felt like I was dying. It was almost like a violent experience. I felt like I was going insane and losing control. My heart pounded really hard and there was this strong feeling of impending doom. After that, I began to worry that it was going to happen again, and that made things even worse."
People who experience panic attacks have feelings of terror, intense fear and an impending sense of danger that strike suddenly and repeatedly with no warning. They may have thoughts of doom or a fear of dying or of going insane. Physical symptoms such as dizziness or shortness of breath can occur, and the buildup of these symptoms can peak within several seconds to 10 minutes from when they begin.
In addition, because they can't predict when a panic attack will occur, those who suffer from panic attacks can develop intense anxiety between each attack, worrying when and where the next one will happen. They may also have a fear of being in places that might trigger an attack. Because of this, some people's lives become greatly restricted: they may avoid normal, everyday activities or they may only go into certain places or situations if they ask a trusted person to go with them. Because of the intensity of the experience of panic attacks, some people develop depression or cope through alcohol or other drug use.
The cause of panic attacks is not known, but it often runs in families. Also, the buildup of stress, traumatic events from the past, or heavy drug use (marijuana, stimulants, or caffeine) can result in panic symptoms.
So what are the symptoms of panic? They can include the following:
- Accelerated heart rate
- Chest pain
- Fears of losing control, dying, or going insane
- Hot or cold flashes
- Nausea/queasy stomach
- Shaking or trembling
- Shortness of breath
- Thoughts of being in danger and feeling unable to cope
- Tingling or numbness
Panic attacks strike between three and six million people in the U.S. It is twice as common in women as in men. It can appear at any age, but most often it begins in young adults like many students on our campus.
"My fear would happen in any social situation. I would be anxious before I even left the house, and it would escalate as I got closer to class, a party, or whatever. I would feel sick to my stomach. It almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else."
A phobia is a fear of a specific object, activity or situation that is so strong that you avoid anything that triggers your fear. It is different from ordinary, everyday fears because it causes you to stop doing things you used to enjoy doing. When the fear hits, the person can experience his or her heart racing, have difficulty breathing, and may tremble and sweat. There are 2 types of phobias: social phobia and specific phobia.
Social phobia is an intense fear of becoming humiliated or embarrassed in situations involving other people. Social phobia often begins in adolescence when teenagers fear being seen as weak, "crazy," or stupid. Small mistakes may seem much more exaggerated than they really are. Blushing may feel embarrassing. The person with a social phobia often feels as if all eyes are focused on her or him. The most common social phobia is a fear of public speaking, although it at times involves a general fear of social situations such as parties or eating out.
People with specific phobias experience extreme, disabling and irrational fears of certain things or situations such as closed-in places, heights, escalators, tunnels, bridges, flying, and water. These fears can lead to distress, panic, and avoidance of these things or situations that frighten the person. Specific phobias strike more than 1 in 10 people, seem to run in families, occur slightly more often in women than men, and usually first appear in adolescence or young adulthood.
"I was raped when I was 20 years old. For a long time, I spoke about it on an intellectual level, as though it was something that happened to someone else. Then I started having flashbacks. They kind of came over me like a splash of water. I would be terrified. Suddenly, I was reliving the rape. Every instant was startling. I felt like my entire head was moving a bit, shaking, but that wasn't so at all. I would get dry mouth and my breathing changed. I felt like I was held in suspension, like in a bubble. It was really scary."
Post-traumatic stress is a reaction someone has to a terrifying event, such as a rape or assault, war, child abuse, natural disasters, or life-threatening accidents. Someone with post-traumatic stress may relive the event by having unwanted flashbacks, nightmares, or sudden intense emotions such as being startled easily, being irritable or angry easily, or being aggressive. Often anniversaries of the event are difficult and can trigger these emotional reactions.
Post-traumatic stress can also lead people to shut off the outside world. They may avoid reminders of the terrifying event that happened to them, including certain people, places or activities. They may forget all or part of the event and the details of the event. They may grow numb emotionally, especially to those around them who they were once close to. They may also lose hope for the future.
Post-traumatic stress can occur at any age. The symptoms can be mild or severe, although the symptoms seem to be worse if the event that triggered them was initiated by a person, such as a rape. Not everyone who experiences a traumatic event will develop post-traumatic stress. Some people recover within several months, while others have symptoms that can last for years. Often, symptoms may not show up until years after the traumatic event.
Obsessive compulsive syndrome
"I couldn't do anything without rituals. They were part of every aspect of my life. Counting was big for me. When I set my alarm at night, I had to set it to a number that wouldn't add up to a "bad" number. I would wash my hair three times instead of once because three was a good number and one wasn't. I was always worried that if I didn't do something, my parents were going to die. Or I would worry about harming my parents, which was completely irrational. I knew these rituals and routines didn't make sense, but I couldn't seem to overcome them."
People with obsessive compulsive syndrome or disorder (OCD) often have repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control. Someone may be obsessed with germs or dirt so she washes her hands over and over. Another person with OCD may be preoccupied with doubt about having done something, such as turning off the stove or locking the door, so he may check repeatedly to make sure that action was completed. Still someone else with OCD may have the worry that he will do something violent or inappropriate and therefore spend long periods of time touching things, counting or are preoccupied by order or symmetry to calm his worries.
The disturbing thoughts or images that are part of OCD are called obsessions and the rituals that are performed to try to prevent or get rid of the thoughts are called compulsions. There is no pleasure in carrying out the rituals, only temporary relief caused by the obsession.
Many people can identify with having some of the symptoms of OCD, but to have a diagnosis of this syndrome, the compulsions should last at least an hour a day, are very distressing, and interfere with daily life. Most people with the syndrome recognize what they're doing doesn't make sense, but they can't stop it.
Both men and women are affected in equal numbers by OCD. It can appear in childhood, adolescence, or adulthood, but on the average it shows up in teen years or early adulthood.
"I don't know why it happens, but before every exam I get incredibly anxious. It actually starts when I'm studying for the exam. It can get so that it affects my focus when I'm studying, the way that I understand the questions on the test, and even my ability to remember things that I know I had memorized."
Test anxiety is a type of "situational anxiety" or "anticipatory anxiety" that occurs while taking or preparing to take an exam. While some anxiety is natural to keep you mentally and physically alert, text anxiety causes physical distress, emotional upset, and concentration difficulties.
People who experience test anxiety can experience rapid heart rate, muscle tension, queasiness, dry mouth, or perspiration. They may find it hard to make decisions, express themselves, read or understand questions, organize thoughts, or retrieve key words and concepts. For some people, they may even have the experience of going blank on questions and then remembering the answers after the exam is over.
Several things can lead to test anxiety, including past experiences of blanking out on tests or being unable to retrieve answers to questions on an exam. It also can result from negative thinking and worries, such as focusing on past poor performances on exams, how friends and other classmates are doing on the exams, or the negative consequences someone expects will happen if she does poorly on the exam.
There are several different types of treatment for anxiety. Some treatments can help with certain types of anxiety, while other treatments are geared for the specific type of anxiety someone is facing. For example, one of the first things anyone should do is check with their doctor to make sure their anxiety is not due to a medical condition. In addition, lifestyle changes can help almost anyone with anxiety symptoms. Such changes can be getting enough sleep each night; exercise; decreasing caffeine, alcohol or other substance intake; changing eating habits that might include decreasing sugar intake; talking more regularly with a trusted friend or family member; and increasing relaxing and self-soothing activities.
Therapy is also an effective way to treat anxiety. By meeting with a counselor, someone with anxiety can learn to replace anxious or compulsive thoughts and actions with positive, rational ones. She can also gradually learn new coping skills such as controlled breathing, muscle relaxation, meditation, visualization (where someone imagines a calming, soothing scene or person to decrease their anxiety), or other relaxation strategies. The therapy can also be a place where the anxious person works on expressing feelings which can have the effect of reducing anxiety symptoms.
Medication in some instances can also be effective in treating anxiety. In most cases, medication works best in conjunction with therapy. When medication is advised for anxiety, it must be prescribed by a doctor who has assessed the symptoms and determined which medication is best.
Perhaps one of the most important things to know about treating anxiety is that it can take some time before one sees the benefits from the specific type of treatment. The main point for people with anxiety to remember is to be patient, keep practicing the skills they are learning, and take notice of the small steps of progress they are making as they treat their anxiety.
As always, for any range of emotional issues you may be struggling with, contact the Residential Life Counselor at (415) 405-4415 or the Counseling and Psychological Services Center at (415) 338-2208 for support.