What is the relationship between anxiety and worry? Can an individual worry and not feel anxious? Similarly, can an individual feel anxious but
not worried? The age-old debate of which
came first…the chicken or the egg once again applies. In today’s post, I will discuss anxiety,
theories of anxiety’s relationship to worry, its physiological symptoms and its
origins. The next post will discuss
treatment options.
WHAT IS WORRY?
Is worry merely a different name for anxiety? Worry is an integral component of anxiety,
although worry is a process that can exist in the absence of anxiety. Let’s identify worry as a primarily mental
(thinking) activity. When an individual
worries, their mind is preoccupied with fear or dread. Often thoughts have a
prevailing theme of negativity - rehearsing the worse case scenarios. Worry can
range from the nagging little voice inside your head to unrelenting obsessions
that can neither be ignored nor quieted.
Depending upon the severity of the negative thoughts and the permanency
of those thoughts (statements that begin with never or always) some
level of physiological reaction frequently follows. Ultimately the mind convinces the nervous
system to prepare for battle. This then
triggers a fairly predictable sequence of autonomic physical symptoms that
characterize anxiety (e.g., fear, racing heart, sweating & tingling
sensations). In this theoretical
framework, anxiety is identified as the reactive symptoms an individual feels
within their body in response to their mental state of worry.
An alternative theory suggests that when an individual feels
a myriad of undesirable physical symptoms that seemingly “come out of the blue”
they often question their origin (a mental process) and may begin to either
hyper-focus on the severity of the physical sensations or obsess about an
ultimately fatal outcome when these symptoms worsen. Worry is the mental
process triggered by feeling anxious rather than the cause of the anxiousness.
Ultimately when worry sets in the autonomic system prepares either to take
flight or to fight. Some individuals may
then experience the very scary physical symptoms known as a panic attack. Following this logic, a panic attack is an
extreme physical manifestation of anxiety. Understand that an individual may
feel both worried and anxious and not
experience a panic attack.
What conclusions can we draw from this chicken or egg
debate? Both positions identify a
relationship between the mental processes and the physical symptoms that define
the term anxiety. Anxiety is neither all
bad nor is it always a diagnosable condition!
Historically it has served as an alerting and preparation mechanism to
safeguard us from impending danger. For
anxiety to meet DSM-V diagnostic criteria symptoms must be frequent, extreme
and a source of ongoing distress (at least six months).
SYMPTOMS
Many symptoms of anxiety can mimic those of a heart attack -
if you experience them seek medical attention immediately! Anxiety can present
as chest pain or tightness in the chest, numbness and/or tingling in the arms
and/or legs, labored breathing (as if an elephant is sitting on your chest),
racing heart, cold sweats, dizziness, chills, tightness in the throat, elevated
blood pressure, ringing in the ears, restlessness and/or agitation,
gastrointestinal distress and most frequently a profound sense of impending doom.
Remember that when we’re anxious our bodies are activated to
either flee or fight. A great illustration of this phenomenon has been captured
by many National Geographic documentaries that feature hunting behaviors of
animals in the wild. The predator (lion)
stalks and takes chase after unsuspecting prey (gazelle). The gazelle exhibits the flight mode, the
lion the fight mode. Our brains have not
yet evolved beyond these basic primal responses!
Additional physical symptoms of anxiety may include a cluster
of symptoms characterized by tension: feeling keyed up or on edge,
irritability, muscle tension, fatigue and sleep impairment. Sleep impairment may range from difficulty
falling asleep to early awakening to unsatisfying sleep (sleeping but not feeling
rested). Cognitive symptoms of anxiety
may often include a temporary inability to recall names, events and previously
over-learned information (mind going blank). The best example of this
phenomenon is test anxiety-despite knowing the topic, the test appears to be
written in a foreign language because the student cannot remember
anything. When a person feels anxious,
it can also seem that any attempt to learn or take in new information is
impossible. This is another example of
the mind going blank. Once the anxiety
dissipates, cognitive abilities return to their normal level of functioning. In
summary, while the symptoms of anxiety are specific to the individual, general
themes involve cardiac-like symptoms, tension symptoms and cognitive symptoms.
Now let’s look at who, what and where regarding anxiety.
ORIGINS
Recent statistics indicate as of 2011, anxiety surpassed
depression as the primary complaint identified by patients to their general
practitioner. Historically, women have
been twice as likely as men to present with symptoms of anxiety. Recent literature also suggests that men may
be closing this gap as anxiety becomes less stigmatized within the general
population. Anxiety appears to be more
prevalent in developed countries and spreads across lifespans. The differentiating factors are age-related
concerns. For example, children may
exhibit anxiety regarding school concerns while adolescents may be more likely
to report anxiety regarding dating, school and independence. Adults may report anxiety regarding advanced
education, professional growth, marriage, families and aging parents. The elderly may exhibit anxiety regarding
their declining health status, grief from significant losses and their own death.
The Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition, cites “childhood adversities and parental overprotection” as
risk factors for developing anxiety.
Also reported in this edition is that one-third of the risk of
developing a diagnosable anxiety disorder may be related to genetic
transmission. This is roughly equivalent
to the genetic factors associated with a diagnosis of major depression. The
balance of the contributing influences may be related to personal
temperament. This means that certain
individuals who are harm avoidant, behaviorally inhibited and display negative
affect may be more susceptible to developing an anxiety disorder compared to
individuals who are more comfortable with risk, are behaviorally extroverted
and display positive affect.
CONCLUSION
As I stated earlier in this post, if you intermittently
worry and feel anxious, that may simply be a reaction to specific life events
and completely normal: life can be stressful!
To meet diagnostic criteria, symptoms must be extreme, chronic and
incapacitating. The presence of panic
attacks, symptoms that necessitate frequent emergency room visits and symptoms
that render an individual unable to maintain appropriate daily self-care and
social relatedness are of significant concern to both behavioral health and
primary care professionals. In these instances, after a thorough evaluation, a
diagnosis of anxiety may be warranted.
Stay tuned for Part II where I will discuss treatment
options. Specifics regarding panic
attacks will be discussed in a dedicated post on that topic.
