Anxiety

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What is Anxiety?

Anxiety is a normal human emotion that everyone experiences at one time or another, usually as a response to stress. It occurs when you worry, get nervous, or feel lack of emotional control when faced with a challenging situation. It may occur in a variety of situations, for instance when speaking in public, when taking a test, interviewing for a job, or when going through everyday stressors related to life events.

The symptoms you experience during moments of anxiety may be mild, or they may be severe enough that they are debilitating and may negatively impact your day-to-day life. The question is, how do we know when we are experiencing a normal response to anxiety as opposed to an abnormal or uncontrollable response to anxiety which requires treatment?

Anxiety and The Brain

The emotional processing centers reside deep in the brain in the limbic system. This system of structures, found deep inside the cortex, is considered to be the most primitive system in the brain. It’s structures are responsible for emotional responses, memories about past experiences, motivations for actions, and processing of all the sensory information we receive from our environment. The limbic system influences our endocrine system, which is involved in such functions as hormone secretions, and the autonomic nervous system. This is why we may experience physical symptoms, such as increased heart rate, muscle tension, and/or sweating palms, when we experience anxiety and stress.

The limbic system also connects to the front of the brain, the prefrontal cortex, which is the thinking part of the brain responsible for executive functions such as goal-directed behavior and decision-making processes.

The prefrontal cortex is the rational part of the brain, and through its connections with the limbic system, the emotional brain, it has the power to control and manage the signals coming from it. For example, when the limbic system provides a signal to produce fear-like symptoms, but there is nothing fearful present, the prefrontal cortex can control this response to decrease or eliminate these symptoms and control the anxiety.

If this control does not occur, the resulting behavior manifests as anxiety. The neurobiology of anxiety disorders includes functional hyperactivity in the limbic system, particularly the amygdala, and the inability of higher cortical executive areas, in the prefrontal cortex, to normalize the limbic response to stimuli.

Types of Anxiety Disorders

The current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) recognizes eleven different types of anxiety disorders. Some of the anxiety disorders are considered short-term and resolve with the removal of an identified stressor and others are considered long-term, many of which start in childhood and last into adulthood.

The short-term anxiety disorders are as follows:

  • Acute Stress Disorder
  • Adjustment Disorder with Anxious Features
  • Substance-Induced Anxiety Disorder

The long-term anxiety disorders are as follows:

  • Agoraphobia
  • Anxiety secondary to medical condition
  • Generalized Anxiety Disorder
  • Obsessive-Compulsive Disorder
  • Panic Disorder
  • Post-Traumatic Stress Disorder
  • Social Phobia, Social Anxiety Disorder
  • Specific Phobia, Simple Phobia

Common Signs and Symptoms of an Anxiety

Anxiety is considered to be a normal response to a variety of stressors in life, for instance, before an exam, an interview for a new job, or a performance. There are several distinctions, however, between what is considered a normal response to these stressors and what is considered dysfunctional. Some key differences between normal anxiety and anxiety that may be diagnosed as a disorder, which requires intervention, are as follows:

  • Constant feelings of stress and anxiety even when a stressor is not present, feelings are chronic and persistent in nature
  • Intensity of the emotional and physical response is high
  • Length of time the individual experiences the intense feelings of stress, i.e. many weeks before the exam as opposed to the night before an exam
  • Presence of other symptoms such as physical symptoms and cognitive symptoms
  • Impaired daily functioning
  • Obsessive thoughts that create fear

Common Comorbidities

Anxiety is an umbrella term often used to label all varieties of anxiety disorders. The reality is that there are many different types of anxiety-based disorders. Often people have more than one type of anxiety disorder but are not always diagnosed with more than one type. For instance, many individuals with generalized anxiety disorder will develop social anxiety and/or panic disorders which become secondary diagnoses. When anxiety co-exists with other diagnoses, the clinical picture becomes much more complex, and the manifestations of anxiety will vary tremendously. The clinical picture will also change depending on the individual’s age and stage of development. Some other disorders that are comorbid with anxiety include:

  • Depression
  • ADHD
  • Autism Spectrum Disorders
  • Developmental Disorders
  • Cognitive Impairments
  • Mental Retardations
  • Organic Brain Disease
  • Endocrine Disorders-Thyroid disorders
  • Central Nervous System Injuries involving the prefrontal cortex
  • Cardiovascular Disorders-Mitral Valve Prolapse
  • Insomnia and other sleep disorders
  • Learning Disabilities