Anxiety Disorders

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe.

Everyone has feelings of anxiety at some point in their life – for example, you may feel worried and anxious about sitting an exam,or having a medical test or job interview. During times like these, feeling anxious can be perfectly normal. It’s a normal part of life to experience occasional anxiety.

However, some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily lives. They may experience anxiety that is persistent, seemingly uncontrollable, and overwhelming. If it’s an excessive, irrational dread of everyday situations, it can be disabling. When anxiety interferes with daily activities, you may have an anxiety disorder.

Anxiety disorders are real, serious medical conditions – just as real and serious as physical disorders such as heart disease or diabetes. Anxiety disorders are the most common and pervasive mental disorders in the UK.

The term “anxiety disorder" refers to specific psychiatric disorders that involve extreme fear or worry, and includes generalized anxiety disorder (GAD),  panic disorder and panic attacks, agoraphobia, social anxiety disorder, selective mutism, separation anxiety, and specific phobias.

Anxiety can be experienced in lots of different ways. If your experiences meet certain criteria your doctor might diagnose you with a specific anxiety disorder.

Some commonly diagnosed anxiety disorders are:

  • Generalised anxiety disorder (GAD) – this means having regular or uncontrollable worries about many different things in your everyday life. Because there are lots of possible symptoms of anxiety this can be quite a broad diagnosis, meaning that the problems you experience with GAD might be quite different from another person’s experiences.
  • Social anxiety disorder – this diagnosis means you experience extreme fear or anxiety triggered by social situations (such as parties, workplaces, or any situation in which you have to talk to another person). It is also known as social phobia.
  • Panic disorder – this means having regular or frequent panic attacks without a clear cause or trigger. Experiencing panic disorder can mean that you feel constantly afraid of having another panic attack, to the point that this fear itself can trigger your panic attacks.
  • Phobias – a phobia is an extreme fear or anxiety triggered by a particular situation (such as social situations) or a particular object (such as spiders).
  • Post-traumatic stress disorder (PTSD) – this is a diagnosis you may be given if you develop anxiety problems after going through something you found traumatic. PTSD can cause flashbacks or nightmares which can feel like you’re re-living all the fear and anxiety you experienced during the actual event.

When is anxiety a mental health problem?

Anxiety can become a mental health problem if it impacts on your ability to live your life as fully as you want to. For example, it may be a problem for you if:

  • your feelings of anxiety are very strong or last for a long time
  • your fears or worries are out of proportion to the situation
  • you avoid situations that might cause you to feel anxious
  • your worries feel very distressing or are hard to control
  • you regularly experience symptoms of anxiety, which could include panic attacks

you find it hard to go about your everyday life or do things you enjoy.

Post Traumatic Stress Disorder (PTSD)

 

Post-traumatic stress disorder is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.

It’s normal to have upsetting memories, feel on edge, or have trouble sleeping after this type of event. At first, it may be hard to do normal daily activities, like go to work, go to school, or spend time with people you care about. But most people start to feel better after a few weeks or months.

If it’s been longer than a few months and you’re still having symptoms, you may have PTSD. For some people, PTSD symptoms may start later on, or they may come and go over time.

What factors affect who develops PTSD?

PTSD can happen to anyone. It is not a sign of weakness. A number of factors can increase the chance that someone will have PTSD, many of which are not under that person’s control. For example, having a very intense or long-lasting traumatic event or getting injured during the event can make it more likely that a person will develop PTSD. PTSD is also more common after certain types of trauma, like combat and sexual assault.

Personal factors, like previous traumatic exposure, age, and gender, can affect whether or not a person will develop PTSD. What happens after the traumatic event is also important. Stress can make PTSD more likely, while social support can make it less likely.

What are the symptoms of PTSD?

PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. They also may come and go over many years. If the symptoms last longer than four weeks, cause you great distress, or interfere with your work or home life, you might have PTSD.

There are four types of symptoms of PTSD but they may not be exactly the same for everyone. Each person experiences symptoms in their own way.

  1. Reliving the event (also called re-experiencing symptoms). You may have bad memories or nightmares. You even may feel like you’re going through the event again. This is called a flashback.
  2. Avoiding situations that remind you of the event. You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
  3. Having more negative beliefs and feelings. The way you think about yourself and others may change because of the trauma. You may feel guilt or shame. Or, you may not be interested in activities you used to enjoy. You may feel that the world is dangerous and you can’t trust anyone. You might be numb, or find it hard to feel happy.
  4. Feeling keyed up (also called hyperarousal). You may be jittery, or always alert and on the lookout for danger. Or, you may have trouble concentrating or sleeping. You might suddenly get angry or irritable, startle easily, or act in unhealthy ways (like smoking, using drugs and alcohol, or driving recklessly.

What other problems do people with PTSD experience?

People with PTSD may also have other problems. These include:

Feelings of hopelessness, shame, or despair

Depression or anxiety

Drinking or drug problems

Physical symptoms or chronic pain

Employment problems

Relationship problems, including divorce

In many cases, treatments for PTSD will also help these other problems, because they are often related. The coping skills you learn in therapy can work for PTSD and these related problems.

Fears and Phobias

 

A phobia is an intense, irrational fear. A phobia is an exaggerated and irrational fear. Phobias can be a source of genuine and ongoing distress for an individual. However, they are treatable in most cases, and very often the source of fear is avoidable.

The term ‘phobia’ is often used to refer to a fear of one particular trigger. However, there are three types of phobia recognized by the American Psychiatric Association (APA). These include:

Specific phobia: This is an intense, irrational fear of a specific trigger.

Social phobia, or social anxiety: This is a profound fear of public humiliation and being singled out or judged by others in a social situation. The idea of large social gatherings is terrifying for someone with social anxiety. It is not the same as shyness.

Agoraphobia: This is a fear of situations from which it would be difficult to escape if a person were to experience extreme panic, such being in a lift or being outside of the home. It is commonly misunderstood as a fear of open spaces but could also apply to being confined in a small space, such as an elevator, or being on public transport. People with agoraphobia have an increased risk of panic disorder.

Specific phobias are known as simple phobias as they can be linked to an identifiable cause that may not frequently occur in the everyday life of an individual, such as snakes. These are therefore not likely to affect day-to-day living in a significant way.

Social anxiety and agoraphobia are known as complex phobias, as their triggers are less easily recognised. People with complex phobias can also find it harder to avoid triggers, such as leaving the house or being in a large crowd.

A phobia becomes diagnosable when a person begins organising their lives around avoiding the cause of their fear. It is more severe than a normal fear reaction. People with a phobia have an overpowering need to avoid anything that triggers their anxiety.

Symptoms

A person with a phobia will experience the following symptoms. They are common across the majority of phobias:

  • a sensation of uncontrollable anxiety when exposed to the source of fear
  • a feeling that the source of that fear must be avoided at all costs
  • not being able to function properly when exposed to the trigger
  • acknowledgment that the fear is irrational, unreasonable, and exaggerated, combined with an inability to control the feelings

A person is likely to experience feelings of panic and intense anxiety when exposed to the object of their phobia. The physical effects of these sensations can include:

  • sweating
  • abnormal breathing
  • accelerated heartbeat
  • trembling
  • chest pains or tightness
  • butterflies in the stomach
  • confusion and disorientation
  • nausea
  • dizziness
  • headache

A feeling of anxiety can be produced simply by thinking about the object of the phobia.

 

The most common specific phobias  include:

  • Claustrophobia: Fear of being in constricted, confined spaces
  • Aerophobia: Fear of flying
  • Arachnophobia: Fear of spiders
  • Driving phobia: Fear of driving a car
  • Aquaphobia: Fear of water
  • Acrophobia: Fear of heights
  • Escalaphobia: Fear of escalators
  • Tunnel phobia: Fear of tunnels

Addiction

 

Addiction is a condition of being abnormally dependent on some habit, behaviour or repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable.

People with an addiction do not have control over what they are doing, taking or using. Their addiction may reach a point at which it is harmful.

If you have an addiction, you’re not alone. According to the charity Action on Addiction, 1 in 3 people are addicted to something.

Addiction is defined as not having control over doing, taking or using something to the point where it could be harmful to you.

Addiction is most commonly associated with gambling, drugs, alcohol and nicotine, but it’s possible to be addicted to just about anything, including:

  • work – some people are obsessed with their work to the extent that they become physically exhausted; if your relationship, family and social life are affected and you never take holidays, you may be addicted to work
  • internet – as computer and mobile phone use has increased, so too have computer and internet addictions; people may spend hours each day and night surfing the internet or gaming while neglecting other aspects of their lives
  • solvents – volatile substance abuse is when you inhale substances such as glue, aerosols, petrol or lighter fuel to give you a feeling of intoxication
  • shopping – shopping becomes an addiction when you buy things you don’t need or want to achieve a buzz; this is quickly followed by feelings of guilt, shame or despair

What causes addictions?

There are lots of reasons why addictions begin. In the case of drugs, alcohol and nicotine, these substances affect the way you feel, both physically and mentally. These feelings can be enjoyable and create a powerful urge to use the substances again.

Gambling may result in a similar mental “high" after a win, followed by a strong urge to try again and recreate that feeling. This can develop into a habit that becomes very hard to stop.

Being addicted to something means that not having it causes withdrawal symptoms, or a “come down". Because this can be unpleasant, it’s easier to carry on having or doing what you crave, and so the cycle continues.

Often, an addiction gets out of control because you need more and more to satisfy a craving and achieve the “high".

How addictions can affect you

The strain of managing an addiction can seriously damage your work life and relationships. In the case of substance misuse (for example, drugs and alcohol), an addiction can have serious psychological and physical effects.

Some studies suggest addiction is genetic, but environmental factors, such as being around other people with addictions, are also thought to increase the risk.

An addiction can be a way of blocking out difficult issues or self-medicating. Unemployment and poverty can trigger addiction, along with stress and emotional or professional pressure.

Relapse Prevention

 

Relapse prevention and management is the main goal when trying to reduce or eliminate drug or alcohol use – the path through the stages of change is not smooth for anyone. However there are a number of relapse-prevention and management strategies that can be used.

Even when the person is extremely motivated to change their lifestyle and drug or alcohol use, it is probable that they will encounter situations that encourage drug or alcohol use. This may be due to the way they are feeling (low mood, anxiety, craving for the drug) and/or circumstances that are conducive to drug use (e.g. friends pressurising them into using, stress in relationships or at work).

There are some essential ingredients of relapse (lapse) prevention and management. These include the following:

  • Acknowledging that a lapse is a normal experience and should not be viewed negatively. Peers/friends are not likely to have any difficulty with this concept, but family members and workers often equate a lapse with the ‘beginning of the end’. Both the young person and their families should be helped to adopt an attitude that lapses provide opportunities for learning how to avoid further lapses.
  • Strengthening the motivation to change throughout the change process. Discuss with the young person (at a time that feels right for them) the need to revisit the pros and cons for maintaining change.
  • Identifying high-risk situations (that include factors both internal and external to the young person). High risk factors for young people will not uncommonly include their friends and families under certain circumstances. It will help enormously if others can be aware which of their behaviours help protect against relapse and which serve as triggers. For example, a common trigger is monitoring the young person’s every movement, so that they feel they are not trusted or sufficiently independent. This is a sure recipe for resentment and secretiveness, which is associated with relapse.
  • Developing coping strategies and skills to avoid high-risk situations and to deal with them when they are unavoidable. One of the foremost strategies to cope with high-risk situations is to turn to prearranged supportive people such as friends and family members. Help the young person discover and participate in non-drug related alternative behaviours with friends and family to combat a possible lapse.
  • Recognising and implementing changes to the person’s environment and lifestyle to minimise the frequency of high-risk situations and to strengthen their commitment to change.
  • Positive self-talk: the person can be helped to develop a phrase or two to repeat to themselves when tempted to use (or go beyond their limit). This phrase should be positive in tone so that it also helps to build their self-esteem (e.g. ‘I’ve gone without before, so I can do it again‘.). It would be useful for a friend or family member to help the young person develop their phrases, and could share in this process by occasionally repeating it aloud to the young person when they indicate they are feeling vulnerable.
  • Problem-solving skills Enlisting family and friends in problem-solving will greatly increase the range of solutions to choose from.
  • Relaxation skills. Change is stressful! Being able to relax will help to maintain change and face challenges. Craving for a drug is a very stressful experience. One of the ways of countering cravings is by relaxing and thereby reducing arousal levels. Some friends/peers, family members and situations will be an aid to relaxation, others definitely will not! There is no one way of achieving relaxation. Relaxation can also follow arousal associated with exciting risk-taking activities.
  • Anger and depression management. Negative mood is associated with relapse, so mood needs to be monitored and dealt with before it builds up to a crisis. Anyone close to the young person (including the worker) can often detect the early stages of trouble brewing. They can also be the targets of anger, and so conflict resolution skills offer a huge advantage.

Coping with craving. Young people and their supporters should be made aware that craving is normal and can be outlasted. Distraction is often useful, but the young person may also want a quiet space to retreat to until the craving subsides.

Addiction relapse prevention environments.

  • Airport
  • Bar
  • Convenience Store
  • Home Alone
  • Liquor Store
  • Loft
  • Paraphernalia
  • Party

Relaxation mindfulness

  • Aquarium
  • Autogenic Training
  • Deep Breathing Relaxation
  • Imagery-Guided Relaxation
  • Mindfulness

Phobia environments

  • Fear of Bridges
  • Fear of Flying
  • Fear of Public Speaking
  • Fear of Storms
  • Fear Heights
  • Fear of Spiders