1d. Fundamentals (Foundations 1/3) – Mental Health: Anxiety (GAD)

If you or someone you know are having thoughts about hurting or killing yourself, please consult a medical professional immediately, call the emergency services or go to the Emergency Department at the nearest hospital. Failing this, call a helpline or a friend.

Go here for emergency numbers and helplines: https://www.opencounseling.com/suicide-hotlines or https://findahelpline.com/i/iasp. Don’t be alone at this time. These thoughts will pass. If this is not an emergency but you have been experiencing thoughts about suicide or hurting yourself, read ‘Suicide’.

If you suspect that you may be experiencing depression or anxiety, please consult a qualified professional as soon as possible and they will take you through different options for treatment. There is strength in seeking help and power in taking action.

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In this part, we will talk about different types of anxiety, their causes, symptoms, signs of anxiety in others, treatments, and my personal experience. In a later section, ‘Triggers and Tools’, we will look at strategies to help.

As with depression, anxiety is complicated and everyone’s experience is different. Anxiety can vary in intensity, and it can be general or specific to certain situations.

As you’ll see below, there are many types and many causes.

Types of anxiety

According to the American Psychiatric Association (APA)’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, the authority for psychiatric diagnoses), these are the different types of anxiety:

Generalized Anxiety Disorder (GAD) – persistent and excessive worry about everything

Agoraphobia – intense fear and anxiety of places or situations that might be difficult to escape

Panic Disorder – unexpected panic attacks

Specific Phobia – strong irrational fears in the presence or anticipation of a specific object, place or situation

Separation Anxiety – excessive fear or worries about separation from home or someone very close to you

Social Anxiety Disorder – intense anxiety related to a fear of being judged, negatively evaluated, or rejected in a social or performance situation

Selective Mutism – unable to speak in certain situations

Substance/medication-induced anxiety disorder – anxiety caused by alcohol or other drugs

Anxiety disorder due to another medical condition

Other specified anxiety disorder

Unspecified anxiety disorder

Quoted and adapted from
https://www.verywellmind.com/dsm-5-criteria-for-generalized-anxiety-disorder-1393147 & https://www.psycom.net/anxiety

When I talk about anxiety, I’m talking specifically about GAD, as this is my field of knowledge and experience. I will also touch on panic attacks. Moving forward, when I use terms like ‘anxiety’ & ‘anxious’, you can assume I’m talking about GAD.

This is a simplified and condensed introduction to anxiety. For a deeper dive, please check out the links throughout and at the end of this post, or read any of my previous writings on the subject.

Causes of anxiety

Family history of anxiety

Trauma

Painful events

Stressful life events

Adapted from https://www.psycom.net/anxiety

Symptoms of Anxiety

According to the DSM-5, a diagnosis of anxiety can be made if the following applies:

Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance)

Difficulty controlling the worry

The anxiety and worry are associated with three (or more) of the following six symptoms (with some symptoms present more days than not during the past six months); only one item required in children:

Restlessness, feeling keyed up or on edge

Being easily fatigued

Difficulty concentrating or mind going blank

Irritability

Muscle tension

Sleep disturbance (insomnia or difficulty falling/staying asleep, or restless, unsatisfying sleep)

The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The disturbance is not attributable to the physiological effects of a substance (e.g., drug abuse or a medication)

The disturbance is not better explained by another medical disorder

Quoted and adapted from https://www.psycom.net/anxiety

Other symptoms of anxiety

Having an increased heart rate

Breathing rapidly, sweating, and/or trembling

Gastrointestinal (GI) problems (including stomachache and nausea)

Inability to relax

Avoidance of stressful situations

Inability to tolerate uncertainty

Feeling overwhelmed

Feeling lightheaded or dizzy

Cold chills/hot flashes and or numbness or tingling sensations

Being easily startled

Aches and unexplained pains

Difficulty swallowing or feeling a lump in your throat

Having to use the bathroom a lot

Quoted and adapted from https://www.psycom.net/anxiety
https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/symptoms & https://psychcentral.com/anxiety/generalized-anxiety-disorder-symptoms#diagnosis

Signs of anxiety in others

Here’s what to look for if you’re concerned about someone else:

Any of the symptoms listed above

Catastrophizing

Overgeneralizing

Avoidance of certain situations or events

Seeking reassurance

Second-guessing

Irritability and frustration in certain situations

Compulsive actions

Social withdrawal

Trouble at work/school

Use of alcohol and other drugs

Depression

Comments (including jokes) about suicide

Poor self-care (e.g. appearance, hygiene, empty fridge/cupboard)

Quoted and adapted from
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/how-to-help-someone-with-anxiety &
https://www.healthline.com/health/recognizing-anxiety-symptoms-signs-and-risk-factors#5

Treatments for anxiety

Medication

Psychotherapy

Cognitive Behavioural Therapy (CBT) – helps recognize and understand thought patterns, develop coping skills

Exposure therapy

Acceptance and Commitment Therapy (ACT) – acceptance, mindfulness, commitment and behaviour change

Dialectical Behaviour Therapy (DBT) – acceptance and change, individual or group therapy, mindfulness, distress tolerance, emotional regulation

Interpersonal Therapy (IPT) – short-term supportive therapy, interpersonal issues of depression, 12-16 one-hour weekly sessions

Eye Movement Desensitization and Reprocessing – helps see disturbing material in a less distressing way

Self-help

Lifestyle changes

Mindfulness practices

Breathing practices

Meditation

Quoted and adapted from https://www.psycom.net/anxiety

We will look at ways to help yourself and others later on in ‘Triggers & Tools’.

My experience of anxiety

Growing up, my experience of anxiety was periodic and usually for short stretches at a time. As I moved toward adolescence, I had the usual worries teenagers have, but I also began to experience what I now recognize as panic attacks (especially in religious settings). I was also dealing with depression. At the time it felt like there was an inner battle for my soul. Now I see it as not understanding what was going on in my mind and body, and not having the tools to cope or the language to express what was happening.

I later experienced more panic attacks as a young adult, but I believe that was probably brought on by my lifestyle choices as a result of depression. Partying, lack of sleep, poor diet, guilt, and shame all fed the monster. Although my lifestyle choices didn’t improve much, I began to develop ways to deal with the anxiety I was experiencing and mostly slumped back into a deep depression to the point that the panic attacks stopped. Throughout these times and throughout my life, I’ve also experienced various gastrointestinal issues which I now believe to be linked to anxiety and possibly depression.

The previously mentioned lifestyle choices and depression also had an impact on my memory and concentration which was later compounded by taking a maximum dose of antidepressants and the whole range of nasty side effects that came with that.

Now, worries became about my memory. I’d cross a doorway in my house and instantly forget why I was there due to brain fog or brain shocks (side-effects of the medicine). I’d leave the house and either have to go back to check if I turned the tap or gas stove off, or worry about it all day and catastrophize about what might happen while I’m away. (There was never a time where the tap or gas was actually on when I left…) This was frustrating but manageable. It made the depression worse but I adapted and was able to handle it.

So on I plodded living with depression (as described in the section on depression).

Years later I moved to another country. I went through a dark time where I was dangerously close to suicide. There were triggers that set me into anxiety loops and killing myself began to make logical sense to me in that state (like a mathematical equation). As described in the section on depression, I managed to pull through with help and a focus on a better future.

I feel like the real learning about anxiety came a few years later in the aftermath of a family member’s suicide (as described in the section on suicide). I learnt about the events that led up to it and began to recognize the mindset they were in and the events that triggered their decline in mental health.

Their death was a turning point in my life – I was determined that some good would come from it. The thought of having a son grow up without a father or with a depressed/anxious/stressed father was too much. I decided I needed to get better. For both of us. This meant learning more about anxiety, coping tools, and my own mind.

This learning curve came quicker than I was expecting. I began a new job as a manager (two years earlier than I’d originally planned). Once I started the job I quickly began experiencing overwhelm and imposter syndrome. The number of situations and amount of work piling up exceeded the available time and my capacity to deal with them. What started as stress escalated into anxiety. As stress and anxiety increased, I began to understand the danger of escalation. This is what seems to have taken my family member’s life – a number of events converging into an unstoppable torrent.

For the reasons stated above, I have found anxiety much harder, more stressful, and more dangerous to deal with than depression. My biggest concern is that it just takes a chain of difficult events and a negative shift in mindset to bring me dangerously close to the edge again. Depression can be a slow build, whereas anxiety usually bursts in at short notice for sometimes seemingly unclear or illogical reasons.

Once triggered my thoughts race and spiral downwards, my heartbeat increases, panic sets in, and I’m gripped by a sense of impending doom. Thoughts of escape rush in. Thoughts of escape turn to thoughts of suicide.

It may seem an illogical leap to someone who hasn’t experienced it, but rational thought goes out the window at this point. Suicidal thoughts are like mould in winter – once they have entered your life it takes a lot of work to eradicate them.

When things are less extreme, thoughts of escape can also take the form of wanting to quit.

I’ve lost count of the number of times I considered quitting as a manager, but I recently turned a corner in my journey and decided that I owe it to myself and my team not to quit. However, I realized I also owe it to my health and my family to leave when the contract is up and dedicate my time to them. I’m quite excited about the plans we’ve made.

Things are improving rapidly with work and my mental state and I’m grateful to my boss for playing a big part in this.

My boss has become a mentor to me, recognizing when I’m struggling and giving me sage, actionable advice for work and for life, while challenging me to help me grow. My mentor knows about my mental health struggle and is one of the most compassionate and supportive people I’ve ever met.

Through following their advice, and through my own experience, exposure and study, I’m learning ways to reduce the amount of stress, worry, and anxiety in my life.

I believe equanimity is possible with daily work and I will overcome depression, anxiety, and suicidal thoughts.

Like depression, anxiety has shaped my thinking and behaviour in many ways to make me who I am today. Fighting it has forced me to be braver, stronger, more compassionate, and more resilient – anti-fragile. This weakness too will become my strength.

What strategies have helped you or a loved one cope with anxiety?

References & Further Reading

Emergency phone numbers and helplines

Find a Helpline

https://findahelpline.com/i/iasp

Open Counseling

https://www.opencounseling.com/suicide-hotlines

Learning about anxiety

Anxiety and Depression Association of America

https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/

Johns Hopkins Medicine

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/how-to-help-someone-with-anxiety