Anxiety is an emotion we all experience. We can all point to a time when we got butterflies in our stomach before giving an important presentation or going on a promising first date. We can all remember worrying about bills that are due, getting our Christmas shopping list done, or completing that task list that seems to have gotten a mile long.
In a way, it is good that we have some levels of anxiety – without any anxiety we would feel perfectly content and complacent, never getting anything done! Anxiety is the way we have adapted to take care of sick loved ones or our own well-being.
Did you see the movie Inside Out? In that movie, the mind of a little girl was “controlled” by her emotions: anger, fear, joy, sadness, and disgust. Throughout the course of the movie, we see different emotions taking over her “control panel,” causing her to act out in different ways. Then at the end of the movie, a much more complex control panel is brought in and replaces the old one as she hits puberty.
While a cute demonstration, in some ways this is exactly how our minds work. Our thoughts and actions tend to filter through a sea of emotions, working in balance with each other. However, trouble arises when one emotion tends to override the rest and take complete command over our own internal control panel.
If you’ve come to this post, you may be feeling like anxiety has complete control of your panel, and you wonder whether you have extreme anxiety. Anxiety looks different in different people, but certain similarities and ways it tends to manifest do exist.
Types of Extreme Anxiety
From here on out I’m going to outline some different types of extreme anxiety, as classified by doctors and therapists, then give some framework for ways to cope with it.
When someone sits down in my office for the first time and says that they are experiencing a lot of extreme anxiety, this is where I generally begin to start my thinking.
We call the experience of a constant state of worry and anxiety Generalized Anxiety Disorder. The name says it all – this occurs when a person is feeling anxiety generally all the time and about most things.
The Diagnostic and Statistic Manual-5 published by the American Psychological Association (2013) defines all mental health disorders, and has the following criteria:
“1. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
2. The individual finds it difficult to control the worry.
3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
Note: Only one item required in children.
- Restlessness, feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Muscle tension
- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
4. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
5. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
6. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in post-traumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).”
That’s a lot of criteria, ya? Now I won’t do this with every type of extreme anxiety I talk about from here on out, but I put this all down so you can see that it’s something we do take seriously as practitioners and there is a lot of qualifications to be met before diagnosing someone with Generalized Anxiety Disorder.
Also, I don’t put this down as a way to self-diagnose either. Diagnosis should always be done by a trained professional who has experience working with people suffering from anxiety.
So to recap the long-winded jargon: Generalized Anxiety Disorder is anxiety that you are experiencing most of the time AND in most situations, with some symptoms such as irritability, fatigue, and/or some physical symptoms/sleep issues. Also, it’s getting in the way of going about the daily routines of your life. Finally, it’s not better explained by something else.
Adjustment Disorder with Anxiety
Now perhaps you read all of the above and thought to yourself, “Well I guess I don’t think I have that many symptoms (or it hasn’t been going on long enough), maybe I’m just overthinking it?”
Well there is a “lighter” form of anxiety, called Adjustment Disorder with Anxiety. Basically, this refers to when someone is experiencing anxiety that is specifically in response to a recent life event or an event that is still ongoing (i.e. a divorce, grad school, a car crash).
This is one of the most common things I see in therapy, so, if this is you, you’re in good company! The criteria is a lot smaller, and usually just refers to some self-reported anxiety about situations and we can generally somewhat easily point to an event that causes this anxiety.
Social Phobia is where we get a little more into a specific type of extreme anxiety. Also known as Social Anxiety Disorder, Social Phobia occurs when people have a hard time in social situations, such as around work, school, or friends and family. People usually can point to experiencing this starting sometime around middle school.
Also, this tends to be a sort of cycle of behavior. You worry about what people think about you, so you act a certain way, then you worry you might be found out for acting that way, so you act another way . . . on and on it goes. Along with that, you may be experiencing a lot of physical symptoms in these situations, such as stomach aches, sweaty palms, elevated heart rate, and dizziness.
If all this occurs in most social situations and you find yourself avoiding them as much as possible (but not outside of social situations), then this might be the sort of anxiety you are experiencing. Good news! We can work with this too, and we’ll get to that later.
Agoraphobia refers to a fear of leaving the house. For some people, there is an immense fear and anxiety surrounding the thought of just leaving the house. If you or they do, they may begin to experience a panic attack, which is comprised of a host of physical symptoms (shallow breathing, sweating, shaking), an overwhelming sense of panic and dread, and immense fear and anxiety. This may last for a few minutes or longer.
Some people can point to the impetus of panic attacks, while for others they appear somewhat randomly. Through a host of exercises, you can learn how to cope with your panic attacks and ultimately diminish their frequency and intensity.
As for the fear of going outside, speaking with a therapist can help to begin to create a sort of gradual process by which you can feel safe leaving the house and ultimately get more freedom back in your life.
Post-Traumatic Stress Disorder (PTSD)
The last form of anxiety I’ll talk about here is Post-Traumatic Stress Disorder (PTSD). While we hear about PTSD in the news all the time, especially in the context of combat veterans, the same sorts of cycles of behavior can be seen in people who have had a traumatic experience. In some ways, PTSD is similar to Adjustment Disorder with Anxiety, cranked up a notch or 10.
People experiencing PTSD will often have flashbacks to the time when experienced the trauma, both while sleeping in the form of nightmares and even during consciousness. For people suffering from PTSD, going about their daily routines is often highly difficult as many things can trigger these flashbacks.
During these, it is normal for people to dissociate or sort of “lose contact” with reality around them as they become immersed in the flashback. After and during these experiences, there are often marked negative changes in your mood.
PTSD can also come not just from one specific experience, but prolonged negative experiences such as abuse or domestic violence. Treating PTSD is often done by a mix of specialized therapies as well as some pharmacological options.
If you find yourself feeling like any of the above might describe what you are going through, first things first – I’d encourage you to look up a therapist. With extreme anxiety, talking about it with a therapist and coming up with ways to cope together can help immensely.
Even if you feel like none of these descriptions were quite “it” for you, come in and we can talk about what your unique experience is and come up with your unique coping skills.
I tend to view anxiety as related to stress. Stress is the outside forces acting on us and anxiety is the internal experience of that stress. Now imagine that your life has a sort of capacity for stress, like a cup. As more and more stress pours in, the water level in that cup begins to rise, getting closer towards the top.
Our capacity is determined by a mix of biological, genetic, social, and psychological factors. Some of us are born with cups that are a little bit smaller and fill up more quickly. For everyone, though, a capacity does exist. When the water fills the cup and it begins to pour over, that’s when we begin to see negative symptoms in our lives.
So what do we do then? First, we see if there’s any stress we can take out. Even if it’s unrelated to the main presenting problem, taking any stress out of our life will help that overall level. Our minds and bodies experience stress in one big general way, not segregated by finances, family, work, etc. Stress is stress and it’s all in the same cup, so taking any out will help the bigger one as well.
Second, we try to build up your cup and see if we can make the walls a little taller, giving you more capacity to deal with that stress. In therapy, we might come up with coping skills to help deal with the emotions that arise and really concrete things to do to get some of that stress out.
Further, things like mindfulness meditation can help slow your heart and breathing rates, forcing your body back into a more relaxed state which will give your mind the capacity to handle what’s in front of it.
For some, medication is a good and necessary option to help with that underlying feeling of dread and anxiety that never seems to go away. Many people begin to function much better once they get on a regular regimen of anti-anxiety medication. Ultimately, the best outcomes usually occur when medication and therapy are used together.
So if you feel like your fear or your anxiety has gotten ahold of the reigns of your control panel a la Inside Out, know that this is something that we can help with! Coming into therapy with myself or another provider will allow you to build up the walls of your cup and let you get back to living life the way you want to. Let’s get anxiety off the controls and let joy get back on charge, shall we?
“Inside Out,” movie cover image courtesy of amazon.com; “Frustrated,” courtesy of Tim Gouw, pixels.com, CC0 License; “Alone,” courtesy of Clem Onojeghuo, pixels.com, CC0 License; “Breathe,” courtesy of pixabay.com, pexels.com, CC0 License