The three faces of anxiety 
By Norman Araiza M.A., May 4, 2007

Imagine a gregarious, energetic and enthusiastic individual. He plans a small dinner party, invites a few friends, spends a little time prettying up the place, only to wake the morning of the planned affair experiencing so much apprehension and dread that he calls and cancels the party. His negative thinking has convinced him he simply can't pull it off. He is sure something will go horribly wrong and he will be humiliated.

Imagine another person standing in line at a bank. Suddenly all of her bodily systems feel as though they are racing in high gear. Her heart rate increases rapidly and seems out of control. She has trouble breathing, her mouth is dry and palms are sweaty. She feels an overwhelming sense of impending doom, all the while struggling to look normal, as if nothing is happening. 

Now consider those who experience tension, dread, skittishness, restlessness or hyperactivity almost daily. These people are so troubled with worry and fear about the direction of their lives, they can hardly cope. Decisions are all but impossible, even those of marginal importance. Second guessing, fretting that the decision was a poor one and the future will prove it so is all-consuming.

This is the private world of people who suffer from anxiety disorders. Their apprehension holds them captive, seemingly alone, regardless of how many people are in their midst. This malady limits their lives like unseen shackles which only they can feel. Some do not even recognize this as out of the ordinary. It is how they are used to feeling, how they have always felt. They consider this so normal they never seek treatment.

It is estimated that 20 percent of the American population suffer from anxiety conditions but only five percent are driven to seek treatment. The stories above are dramatic examples of this classification of disorders. Yet many individuals experience lesser symptoms of the same disorder, and tell themselves they are manageable. The sufferers are unaware of the debilitating effect of this condition on their lives. 

Social Anxiety Disorder

In the first example the condition is known as Social Anxiety Disorder. In most cases a person with this condition may not actually cancel social engagements but will feel so much angst that their spouse and family members suffer as well. Something as common as a ringing phone can trigger anxiety. People who suffer from this disorder usually have difficulty admitting the discomfort even to themselves. Partners are only aware of a sense of disharmony, some irritability and nervousness which surfaces as a social event approaches. In couples with this problem the opposite partner is usually very social and often shoulders most of the social responsibilities for both. People with this disorder are often late to functions, the mental preparation required of them and excessive concern about their appearance can all add to the tension of the moment.

Many people who suffer from this condition are totally unaware that it is highly treatable and they are not the only ones struggling with it. These individuals often lead somewhat reclusive lives or turn to alcohol and drugs to alleviate the symptoms. 

In my experience working with alcoholic clients, once the drinking has stopped, symptoms of this disorder may appear and we learn that the drinking problem is secondary to the primary anxiety disorder. When AA is the only recovery program in which the individual is involved, this condition frequently goes undiagnosed and successful recovery is hampered. Or, the individual may limit his or her social activities to AA functions. This is not meant as a criticism of Alcoholics Anonymous, which I greatly respect, but rather to point out that with alcoholism underlying reasons unrelated to drinking may be at the root of the problem. If those underlying reasons remain undiscovered the quality of recovery and sobriety can be greatly impacted.

Panic Attack

The second example I gave describes a panic attack, a truly horrifying experience that can occur at any time, even during sleep. Thankfully it only lasts for a few minutes, though it may feel like hours. Clients describe them as their most terrifying experience. People who have one attack will have another if they go untreated. Those who have had repeated attacks or suffer severe anxiety about the possibility of further attacks are said to have Panic Disorder. 

The symptoms are strikingly different from other types of anxiety in that panic attacks come on suddenly, are often unexpected, appear to be unprovoked, and are often disabling. This condition does not spontaneously improve—without treatment many sufferers become house-bound and reclusive. 

Because of the severity of the episodes, patients usually go to the emergency room or to their primary care physician where they are often under-treated according to researchers. The patient is told there is “nothing to worry about... it’s only in your head.” As a result it is estimated that as many as 40 percent of panic disorder patients receive only a minimum standard of treatment. 

Contributing to this lack of adequate treatment is the reluctance of some physicians to refer patients to non MD practitioners. Although a panic attack is not organ- threatening—despite how dreadful it feels—if the disorder goes untreated the quality of the person’s life may be seriously affected. Furthermore, attempts to avoid or conceal the symptoms often leads to other social, occupational or family problems.

While the cause of panic attacks is not fully understood at least one theory states that the body's normal fight/flight response gets triggered maladaptively and the reaction sets in. The panic attack is the unconscious mind expressing itself in a most dramatic way about some issue in the person's life, now or in the past. It commands attention and if not heeded, serious life-changing consequences may occur. Often associated with post-traumatic stress disorder, the episodes are unpredictable and may have nothing to do with the current environment. 

Generalized Anxiety Disorder

My third example is of someone suffering with Generalized Anxiety Disorder (GAD), which is characterized by excessive, exaggerated anxiety about everyday life. Symptoms include: muscle tension, an unrealistic view of problems, restlessness or a feeling of being edgy, irritability, headaches, sweating, difficulty concentrating, nausea; the need to go to the bathroom frequently, tiredness; trouble falling or staying asleep, trembling, being easily startled.

For some anxiety begins in the first waking moment. Throughout the day everything is cloaked in worry, concern, and negative thinking. It begins with a voice in the head listing all the possible pitfalls in every under taking. The ringing of the phone, the person at the door, the mail to be opened; all are cause for alarm. The sufferer exists in a heightened state of alertness or near-crisis all the time. This kind of stress will eventually cause some area of the body to break down which is why most patients suffering with GAD learn of this disorder after going to the doctor with some physical complaint. Sufferers don’t consider the anxiety to be a problem and think of it as a normal part of their personality makeup, a part of who they are. They don’t understand that anxiety is not a lifestyle but a serious life-debilitating behavior pattern we create in ourselves and over which we have no control—unless we seek treatment. Once we identify it we can learn how not to create anxiety, and in its place find harmony.

Anxiety is the most common of all psychological problems. But living with anxiety is not normal, nor does it have to be tolerated. While anxiety is a psychological issue, it usually has genetic and physiological components to it. So it isn’t the fault of the individual. Thanks to modern medication and certain forms of psychotherapy which are used to identify the triggers and condition new responses, treatment is usually effective.

These conditions usually respond well to group support. If you are interested in joining others in a support group for those that struggle with anxiety, please call me.

Norman Araiza, MA Psychology, is an American-trained psychotherapist enjoying a limited practice in San Miguel. He can be reached at 152-5454 or email: 2gatos10@cybermatsa.com.mx.