Are Worry and Anxiety Related?

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.

The Trap of Perfection

In my opinion, perfection is highly overrated.  It assumes that a comparison must be made of someone or something – a personal value judgment.  Perfection also implies a judgment of ultimate success or ultimate failure.  Take a moment and define perfection. Does your definition include both positive and negative descriptors (ex. what is and is NOT perfect)? There are many downsides when perfection becomes the goal!   Frequently these downsides are not in our conscious awareness.  This post will explore some of the potentially hidden pitfalls in the quest for perfection and the negative effects they can have on our self-worth and happiness.

The quest to either become perfect or secure the perfect mate, career, physique or even golf swing can be a solitary process.  Often the sheer dedication and focus required in pursuit of perfection promotes isolation. Perfecting any specialized technique, whether it is a three-point shot or a pirouette often demands hours of focused activity.  The sacrifice is social connectedness. Frequently outsiders represent distraction rather than support.   If you happen to be shy or a bit insecure, it is a great way to justify why you need to remain alone. 

The obvious downside to this cover-up is that as an individual you deny yourself the opportunity to challenge your fears or insecurities.  For instance, overcoming shyness or timidity requires practice in various social situations. Isolating to perfect you obviously limits opportunities to develop social confidence.  So what happens when an individual believes they have perfected whatever technique they set out to master? Self-confidence often rises!  However, confidence does not always erase social insecurity and it also does not generate instant friendships. Why?  While focusing on the process of perfection, little if any energy was spent either in creating new or nourishing existing friendships.  So when seeking to celebrate their new found confidence and their perfect technique, this individual may unfortunately remain a party of one. 

The second downside to this particular cover-up is once again based on a relative value judgment.  If you are engaged in the solitary pursuit of perfection, how do you know whether your idea of perfect aligns with someone else’s?  Observing the behaviors of similarly talented individuals can be a great comparative tool, but when do you incorporate outsiders into your quest? Sooner than later would be ideal!  An individual may have attained their personal best, yet may not be able to compete among an equally talented peer group.  This could be a two-fold blow to self-confidence with the realization that: (1) your personal best was not regarded as perfect and (2) the time spent in isolation did not produce the anticipated benefits (acceptance, happiness or popularity).  For example, while you may now have a perfect physique, the attention you imagined you’d receive is not happening in the real world.  The result may be disillusionment and bitterness.  Neither of those energies attracts the type of positive attention you imagined, and again you remain alone.

In the context of personal relationships, seeking perfection may cleverly mask deeper commitment issues.  There is a vast difference between holding fast to personal standards and finding fault with every potential mate while “holding out” for Mr. or Ms. Perfect.  If you find that no one ever measures up: (1) your standards for perfection may be unrealistic; (2) you may be over-estimating your own personal value; or (3) you are unwilling to commit, period. Perfectionists impose far too many rules on themselves and these rules unfortunately spill over onto others.  Rarely will anyone live up to the perfectionist’s fantasy of possibilities. 

One of the many faulty assumptions of perfectionism is that if an individual obeys the rules, then they deserve the long awaited reward (happiness, marriage, wealth, success). Often despite securing the perfect mate or job they are dissatisfied and only marginally happy.  How can this be? The simple answer is that reality rarely measures up to our fantasies.  Perfection is a product of our imagination, our personal beliefs and the norms we learned within our families. It is colored by our personal life experiences and therefore no two definitions are exactly alike. 

The obvious impact of this cover-up is self-imposed chronic isolation!  It can also create a pseudo superiority that masks either an individual’s fear of commitment or simply a lack of desire to commit to anyone.  In both instances the potential mate has been set up for failure – missing the mark of perfection. This is a lose-lose proposition: (1) the self-esteem of the potential mate takes a hit based upon the perceived rejection, and (2) the perfectionist is allowed to avoid taking responsibility for their own commitment issues while focusing on the flaws of the potential mate.  In time, this emotional manipulation may be disguised as a quest for perfection.  

So far we have seen that the pursuit of perfection often backfires and may actually result in a decline in self-esteem, limit potential happiness and promote social isolation.  Yet when many individuals set out to perfect some aspect of themselves, they expect to feel quite the opposite – bountiful happiness, increased confidence and social acceptance.  As adults we are capable of challenging this faulty thinking with the guidance of a mental health professional.  What about our children?

Examine how you may be perpetuating the misguided notion that perfection is the only valuable performance goal.  Reduce the frequency of your use of the word perfect.  How many events, behaviors, grades and performances can be perfect?  Again, overuse of this term sets up unrealistic expectations for our children!  It can actually negate the small victories that drive sustained motivation towards the bigger goal.  It also may lead to a rigidly structured life that over-emphasizes the value of delayed gratification and cements a pattern of chronic disappointment when the rewards are finally granted.  Protect your children from these unnecessary assaults to their self-esteem. Teach them to celebrate each step that is completed towards the larger goal. Reinforce their uniqueness but refrain from idolizing them as perfect.

I believe that our goal both as adults and parents needs to be balance – strive to give your personal best and create meaningful relationships.  Also develop a conscious awareness and acceptance of your vulnerabilities without judging them.  That is a much more attainable goal than the illusion of perfection! 

The Value in Teaching Your Child How to Fail

Our generation, primarily as a knee–jerk reaction to the more harsh parenting techniques that we as children endured, have raised a generation that believes that they can succeed at most everything, are perfect the way they are and really expect to win without expending the necessary effort to truly savor the victory.

This is a slight exaggeration, although it is primarily true. As parents we anguish when our child suffers. Good parents attempt to shelter their child not only from physical, but mental and emotional harm. In its purest form this is exemplary. My question is how does that prepare our precious ones for the world?

Children are cruel. Once your child steps onto the school playground, harsh reality checks begin and for the most part, go uncensored. Unfortunately these reality checks are rarely accurate because their peers, who are of the same generation and who safeguard their own egos at any cost, levy them. Is your child prepared to cope with this embarrassment and blow to their confidence?

Peers, especially as your child enters the tween years and beyond carries much more clout than their parents. What can be created is a dissonance within the child that actually inadvertently lowers their self-esteem. The dissonance is the dichotomy between “I am great” as told to them by their parents and “I don’t measure up,” freely expressed to them by their peers.

This generation is unfortunately at a distinct disadvantage when the real competition begins in high school, college, and ultimately in the corporate world. If a child is shielded from experiencing the agony of defeat, of losing or failing, the perceived impact on them when it inevitably occurs can be devastating as well as over-exaggerated. For example, observe the child who doesn’t get a trophy for coming in fourth place in Little League, or who’s parents don’t complete or help them complete challenging homework and so rather than receiving an ‘A’ they receive a ‘C’ on that particular assignment. By most standards this child failed relative to their peers. Yet, when these children face defeat later in life, they have mental and emotional templates to fall back on that assists them in coping with the hurtful feelings and temporary embarrassment. They can successfully reason with themselves in a very believable way that this event is not catastrophic because they have already been in a similar situation and persevered.

The college coed who lacks such a template because they have never been allowed to fail can develop aversions to challenge, become depressed, panicked and even completely surrender when placed in an academic or athletic environment inhabited by many superstars besides themselves. They often do not know how to express and/or normalize their pain and embarrassment because they have no template... and quite often their parents are not close enough to give them the support they so desperately require.

As adults, how many of you have witnessed this in your own professional environment? Who protests the loudest about inequities in bonus structures, advancement requirements, and workloads? Very often, it is the individual who possesses an over-inflated perception of self and no drive to prove their worth. Those roots run long and deep…long before their most recent promotion. For these individuals, consultation with a licensed professional provides the most opportunity for growth.

So what is the solution as parents? Monitor your children’s activities. Notice whether their activities are unbalanced, meaning that little effort is required of them because your child is a superstar. If they are gifted in sports, add an activity where they may need to struggle to advance. If they are excellent writers, challenge them with math and/or science. The key here is exposure and balance. A child is very able to assess their skill level compared to their peers. Do not over-inflate their accomplishments when they are mediocre. That does not mean that you need to be harsh, it means that you need to be honest.

The parents that I have had the privilege of working with share a universal desire to raise children who, when they leave their nests, have acquired the life skills to cope gracefully with both failure and success. Part of that learning curve is enduring the pain of witnessing your child struggle and the comfort lies in your ability to guide them through it. We have relatively few years to accomplish this goal, so while holding them tightly - be their most honest critic as well as their most loyal fan!