Anxiety: Causes, Symptoms, Therapy

When I was in kindergarten, my teacher and parents agreed to put me in a speech class. My teacher had noticed I tended to shy away from the other children, refusing to participate in class activities, lunch, or cooperate in general. I wasn’t lashing out or causing problems, but I didn’t want to participate in anything. When I did speak up—after much coaxing—it was a quiet, mumble of words that made it hard for anyone to understand me. After a year, a final verdict was called and I attended speech class for about two years.

Yet nothing changed. From second to fifth grade, I shied away from all my classmates, class activities, and refused to participate in anything. I can remember being scared of everyone and being so young, I didn’t try to understand or fight it. It was so bad that I was held back a year when I was in third grade, my school thinking maybe that it was because I was a year younger than the rest of the kids. And to be honest, that might have made it worse: I felt even more scared in a new class with kids I didn’t know at all instead of a class full of kids I didn’t talk to but at least I knew.

My school could go up to sixth grade but my parents wanted to switch me to the middle school to see if that could help me. When they told me, I cried for hours, terrified at having to start a new school with more new people.

Middle school passed the same; quiet, head down, and scared. When changing rooms were introduced, I would literally run from my class to the locker rooms, change, and bolt out before any girl would get inside. During the lunch period I was usually sitting by myself, and if I was offered to sit with others, I would for a couple of minutes before getting overwhelmed and leaving even if no one was talking to me, or just outright denied.

It was around that time, I figured something was wrong. I went to my dad and told him how I was feeling and he contacted the school. The school therapist talked to me for a month before recommending me to a behavioral clinic across town. It was there I would be diagnosed with General Anxiety Disorder and Depression. After being set up with a therapist and starting my Cognitive Behavioral Therapy (CBTs), I would be diagnosed once more a year later with Social Anxiety and continued my therapy for four more years with medication.

Generalized Anxiety Disorder (GAD) is a chronic and disabling condition that is associated with uncontrollable worry and tension. It is a vicious cycle of clouding thoughts of fear with self-deprecation that interferes with all aspects of a person’s life and if left untreated could lead to depression. Anxiety and its associated disorders represent the most common form of officially classified mental illness in America today, more common than even depression as a separate diagnosis or other mood disorders. From what the National Institute of Mental Health reports, nearly 40 million Americans—almost one in seven of us—are suffering from some kind of anxiety disorder at any given time.

The following is the DSM-IV Diagnostic Criteria for 300.02 General Anxiety Disorder from the American Psychiatric Association. This is a list of neurotic tendencies that lays out a format for psychologist and doctors to refer to whenever in the position to diagnose a patient. It is a public text that can be accessed by anyone to give guidance to those who think they might be suffering from anxiety. That said, if you truly feel that these causes and symptoms relate to you in any way, please see a qualified doctor to give you the proper assistance you need:

DSM-IV Diagnostic 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 person 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 present for more days than not for the past 6 months). Note: Only one item is required in children.
1. restlessness or feeling keyed up or on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
4. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Post Traumatic Stress Disorder.
5. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
6. The disturbances is not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g. hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

General Anxiety Disorder is very disabling to a person depending on the levels and situations they find themselves in. For the most part, those suffering with anxiety know it’s unreasonable but mentally or physically cannot stop the panic and fear clawing in their mind and body. It can prevent people from doing activities, jobs, or aspirations they wish to do, and when it does, it takes a toll on their mental health which is one of the reasons why depression is also common with those who suffer from GAD. It’s important for those who think, even question a little to themselves that they have a serious problem to try to seek help so the problem can be maintained and controlled, especially if the situation could be associated with young children.

So what causes anxiety? With so many people affected by anxiety, it makes researchers wonder: why? Is there a definitive reason or cause that creates such severe anxiety? Is anxiety a medical illness, a philosophical problem, a psychological problem, a product of childhood trauma, a spiritual condition, or a cultural condition from the times we live in and the structure of society?

Many researchers suggested that anxiety can come from family traits. Scott Stossel, an author of a New York Best Selling book called My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind, talks about his life living with anxiety. Stossel mentions that his family is full of neurotic anxious people, from him and his mother both sharing every possible fear, his sibling suffering from enough anxiety for therapy and medication, to his grandfather who was put into a mental health institution for the remainder of his life from his anxiety and panic attacks at the age of 60. If, unlike Stossel, the family doesn’t have any history of anxiety, research has come forward that women who are stressed or nervous during pregnancy are 1.5 times more likely to have children who are more anxious and nervous than others.

In a broad sense, the most common reason for general anxiety is due to stress: work, school, family and romantic relationships, financial, anything that affects a person emotionally or physically. General anxiety can come from situations where a person is about to make a big speech or doing anything that causes embarrassment. There are names we’ve created for these situations: "stage fright" or being "shy." The difference is their level of hindrance to a person’s normal routine. For example: one person might feel anxiety just before they give that huge presentation in front of an audience, while another person could be suffering with fear, thinking of ways to escape, sick to their stomach for weeks before having to do the same exact thing. For the most part, general anxiety symptoms come to almost every person: pounding heart, excessive sweating, shortness of breath or hot/cold flashes.

More severe symptoms can come to people without being classified with an anxiety disorder but more often than not happen with anxiety disorder. These symptoms include a choking sensation/difficulty swallowing, nausea/vomiting, and dizzy/lightheadedness. As stress is one of the main reasons for anxiety, for those dealing with severe anxiety, stress can take some uncommon and more rare symptoms like: skin rashes/itching, chest pains, depersonalization (feeling as though you are outside of your own body), tingling or weakness in extremities (fingers, hands, toes, feet), eye pain/strain/vision issues, or even yawning.

One of the most difficult things about General Anxiety Disorder, in my opinion, is the research. The DSM-IV has kept the term “anxiety” since it was introduced in 1987, but before that the term was constantly changing: “melancholy,” “angst,” “hysteria,” “neurosis,” “stress,” “fear,” “psychoneurosis,” “depression,” “phobia,” and so many other terms. So it makes us wonder, what are we talking about when we talk about anxiety? There are some people who say that anxiety is useless as a scientific concept—it is straining to describe a spectrum of human experiences too broad to collect under a single term. In 1949, that was the first academic conference to be held for anxiety; everyone knew what it was but nobody could agree on exactly what it was or how to measure it. Since then the term has been suggested to be dismissed from the DSM volumes and at the same time pushed forward as a serious mental illness. How can we make any progress if can’t even agree on what anxiety actually is, let alone research it correctly?

The closest—and the most comforting research I have found for my own anxiety—comes in two definitions. The first came in 1915 from Walter Cannon, the chair of the physiology department at Harvard Medical School. Cannon coined the term “fight-or-flight” from Darwin’s idea of automatic physical responses. With all animals and birds, skin becomes pale, sweat breaks out, and hair bristles to threats is evolutionary adaptive. Cannon documents on how when the fight-or-flight response activates, blood vessels constrict, directing blood away from extremities to the skeletal muscles so the animal will be prepared to run, which makes our skin look pale. The liver releases an increased amount of glucose which gives energy to various muscles and organs, which can translate to a person’s need to move in any way. Saliva flow decreases, causing the anxious dry mouth feeling and the urge to urinate or vomit, expelling things from the body allows an animal’s internal system to focus on survival needs more than digestion. This research comes from his book Bodily Changes in Pain, Hunger, Fear, and Rage, which also provides experiments that involve the experience of emotion that translates into chemical changes into the body.

For example, they gave nine different students two tests, one hard and one easy. Then, they tested their urine after each test; four of the nine students had sugar in their urine after the hard test, but only one did after the easy test. When the fight-or-flight response activates when there is a legitimate physical danger, it enhances the need to survive. But what happens when it activates inappropriately? A psychological fear response that has no legitimate object to be threatened by can be pathological anxiety—an evolutionary impulse gone awry.

The second comes from Scott Stossel’s therapist Dr. W., a man who has been specialized in treating anxiety for 40 years. His definition boils down to, “the apprehension about future suffering—the fearful anticipation of an unbearable catastrophe one is hopeless to prevent.” It’s this definition that makes it more than just pure animal instinct, and orientates it as a human emotional condition. Animals have no concept of anxiety—they experience the bodily responses, but animals don’t have the ability to worry about their fears. They cannot interpret it in any way. Animals have no fear of car accidents, plane crashes, the loss of people we love, our existence, or death. Our hypochondriac minds gives the human experience of anxiety.

In this way, the ideas behind therapy seems a lot better. The majority of the time GAD will be treated with Cognitive Behavioral Therapy (CBTs) which are one-on-one with a therapist, or group sessions with other GAD patients, to talk about the general areas in life that bring forth the anxiety and focus on those parts. CBTs involve medicine—unless directed by your doctor—like Prozac or Zoloft which are the main ones used. But there are so many more to list: Paxil, Desipramine, Nardil, Lexapro, Celexa, Luvox, Levoxyl, Centrax, etc. There are so many different medications for different levels. Symptoms of one's anxiety, listening to how your body responds, and keeping an open line of communication between you and your therapist is important. Besides using CBTs, there are many different types of therapy to use: family therapy, meditation, role-playing, exposure therapy, self-help work books, massage therapy, acupuncture, yoga, and yes, even hypnosis and prayer. I can tell you that I have been offered and tried all of these suggestions during my years in therapy. I can also tell you that even if these things help for a little bit of time, none of these things were a complete, cure-all miracle worker.

To summarize everything I’ve searched for and compiled: Anxiety is one big emotional ball of complexities that no one will really completely understand. Even the research and definitions I have given up here were just two of the hundreds of different ideas or theories psychologists, therapists, and doctors have been creating for years and years. Those two are the ones I chose because the research portion of this paper was one of the most difficult parts to put together, to try to find an answer or an experiment that communicate the whole of Anxiety. And those two, those are the ones that fit for me on a personal level. I hope with my paper I can encourage others who think they might be struggling with anxiety to do their own research. I don’t want to present a paper to someone with only facts and information about one type of therapy or one type of medicine or even one type of definition. Anxiety is honestly such a broad spectrum of emotions and neurotic meanings. Some things might be perfect for one person, and that same thing might not work at all, or even make it worse. I want to make sure anyone who is struggling can find what fits them and find therapy and medicine that works for them too.