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When Does Anxiety Become A Source Of Clinical Concern

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Anxiety also involves alterations to attentional processes that facilitate threat detection, which result in heightened perceptions of harm: The range of stimuli that can evoke anxiety in generalized anxiety disorder may increase until almost any stimulus is perceived as a danger. This tendency to view ambiguous stimuli as threatening, called interpretation bias, has been observed when patients with GAD are presented with ambiguously described scenarios or spoken words with multiple meanings,,. Disorder-specific interpretation biases have been reported for ambiguous social scenarios and facial expressions in SAD, ambiguous interoceptive cues in PD and sentence stems that could be completed to form combat-related words in veterans with PTSD. Given these interpretation biases, along with increased attention for objectively threatening stimuli , elevated estimates of threat under conditions of uncertainty might reflect adaptive anticipatory responses to a world that appears more dangerous to anxious individuals.

Anxiety Disorders: An Overview

Sanne van Rooij, PhD, and Anaïs Stenson, PhD

In an anxiety-related disorder, your fear or worry does not go away and can get worse over time. It can influence your life to the extent that it can interfere with daily activities like school, work and/or relationships. Fear, stress, and anxiety are “normal feelings and experiences” but they are completely different than suffering from any of the seven diagnosable disorders plus substance-induced anxiety, obsessive-compulsive disorders, and trauma- or stressor-related disorders.

Anxiety disorders keep people from sleeping, concentrating, talking to others, or even leaving their home. Anxiety that may need treatment is often irrational, overwhelming, and disproportionate to the situation. It makes sufferers feel as though they have no control over their feelings, and it can involve severe physical symptoms like headaches, nausea, or trembling. It becomes classified as a disorder when normal anxiety becomes irrational and begins to recur and interfere with daily life.

But, as an example, what if someone will not leave their home for extended periods of time because they are afraid of being in a crowd or being reminded of a past traumatic event. That is not a “normal feeling or experience.”

If you think you might be struggling with an anxiety disorder, you’re not alone:

What Is Almost Anxious And How Can You Handle It

As anxiety moves along the spectrum from normal to clinical, a gray area in the middle may still have a negative impact on your life: the almost anxious region. When the level of anxiety you experience is no longer adaptive or helpful to your performance and becomes a barrier to your enjoyment of life, but does not yet meet the diagnostic threshold for an anxiety disorder, you are almost anxious. You might find yourself struggling to focus your attention on tasks, distracted by negative thoughts, fear, or unpleasant body sensations. For example, someone who is almost anxious may sit at their desk all day, making minimal progress on an assignment due to constant worries and tightness in the stomach. While anxiety did not make it impossible to come to work, the level of anxiety experienced is making it hard to function. Using this concept of almost anxious can help you catch anxiety before it becomes too extreme, and target it using evidence-based strategies that help move anxiety back along the spectrum to an adaptive level.

When you find yourself feeling too anxious, try evidence-based techniques highlighted in the book Almost Anxious to bring your anxiety levels back to normal. Here are a few tools to try:

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How Is Irritable Bowel Syndrome Related To Anxiety Disorders

Some people feel the effects of stress in their stomachs. People with IBS have uncomfortable problems with digestion, including stomach pain, constipation and diarrhea. They also frequently have anxiety and depression, which can make symptoms worse.

The connection between IBS and anxiety comes from the nervous system partly controlling the colon. The nervous systems response to stress may affect the stomach. Among people who get treated for IBS, anywhere from 50% to 90% may also have an anxiety disorder or depression. Treatment for IBS may include stress management and psychotherapy to relieve symptoms.

What It Means To Be Nervous

Myocardial In

Nervousness is a natural reaction to a stressful situation. It usually hits when you face a new or important challenge, such as taking an exam or giving a presentation to a room full of people. You might be nervous when waiting for medical test results lab results or before walking into a job interview.

Many physical sensations can accompany nervousness, including a dry mouth, sweaty palms, and dizziness. You may also experience feelings of self-doubt. These feelings and sensations are both uncomfortable and uncontrollable.

Nervousness tends to go away once you’ve gotten through the situation. And it rarely leads to you avoid nerve-wracking situations in the future.

Feelings of nervousness that don’t disrupt your everyday life are normal.

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Four Ways To Be Anxious

In his book Anxious: the modern mind in the age of anxietyJoseph LeDoux examines four experiences of anxiety through a brain-based lens:

  • In the presence of an existing or imminent external threat, you worry about the event and its implications for your physical and/or psychological well-being. When a threat signal occurs, it signifies either that danger is present or near in space and time or that it might be coming in the future. Nonconscius threats processing by the brain activates defensive survival circuits, resulting in changes in information processing in the brain, controlled in part by increases in arousal and behavioral and physiological responses in the body that then produce signals that feed back to the brain and complement the physiological changes there, intensifying them and extending their duration.
  • When you notice body sensations, you worry about what they might mean for your physical and/or psychological well-being. The trigger stimulus does not have to be an external stimulus but can be an internal one, as some people are particularly sensitive to body signals.
  • Thoughts and memories may lead to you to worry about your physical and/or psychological well-being. We do not need to be presence of an external or internal stimulus to be anxious. An episodic memory of a past trauma or of a panic attack in the past is sufficient to activate the defence circuits.
  • The Impact Of Threat Of Shock On Cognition

    Threat of shock facilitates early sensory-perceptual processing of neutral stimuli, improves the detection of negative information, impairs performance on tasks with emotional distractors, and facilitates resolution of conflict. In addition, threat of shock impairs short-term memory but facilitates long-term memory as well as certain aspects of decision-making and executive function. In general, the changes can be seen as part of an overall adaptive mechanism of harm avoidance in which threatening stimuli are privileged at all levels of cognitive function, but at a potential cost for some functions .

    Thus, anxiety boosts sensory-perceptual processing, which subsequently influences downstream stages of information processing. These effects may be facilitative or detrimental depending on task demands. Consistent with the dual-model process theory and attentional control theory , threat of shock affects the balance between stimulus-driven and goal-directed behaviors , such that performance is improved when emotional information is task-relevant but impaired when it is task-irrelevant.

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    Prevalence Of The Anxiety Disorders

    Accurate estimates of the prevalence of DSM anxiety disorders are only available for children older than 8 years of age because studies of younger children have failed to have population-based samples and clear diagnostic criteria or have failed both requirements. The best estimates of the prevalence of anxiety disorders in preschool children, based on a primary care clinic sample , were very low. The following sections summarize prevalence data based on samples from the general population and studies published over the past decade . The prevalence of any anxiety disorder increases with the duration of time over which the symptom’s presence is counted. Thus 3-month estimates range from 2.2% to 8.6%, 6-month estimates from 5.5% to 17.7%, 12-month estimates from 8.6% to 20.9%, and lifetime estimates from 8.3% to 27%.

    What Causes The Shift From Adaptive To Maladaptive Anxiety

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    As indicated above, there were a number of discrepant effects across threat of shock and anxiety disorders, largely on cold cognitive functions. An important question, therefore, is what drives the difference between the effect of induced-anxiety and anxiety disorders on cold cognitive functions? One possibility is that this discrepancy reveals the differences between adaptive and maladaptive anxiety. Specifically, in a threat of shock experiment, the state of anxiety is entirely rational and an adaptive response to an imminent threat. Anxiety disorders are, however, characterized by anxiety at inappropriate times or to mildly aversive stimuli so called maladaptive anxiety. It will be important to identify the mechanism by which adaptive responding becomes maladaptive. One possibility is that the same processes underlie both effects, but in the case of maladaptive anxiety, the circuitry gets stuck in the anxious state. This causes a broader array of stimuli to constitute threats and impairs the ability to down regulate threats . What causes this switch to occur? Is there a ratcheting effect whereby once the system is pushed too far it is unable to restore healthy function? And once this occurs is that what leads to the cold control impairments which appear to be restricted to anxiety disorders? Clarifying the causes of these differences may reveal important mechanisms of relevance to the development of anxiety disorders.

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    Uncertainty Unpredictability And Uncontrollability

    Unpredictability and uncertainty are highly similar and are often used interchangeably, but have slightly different connotations. Unpredictability is often used in a sense that is more quantitative and amenable to experimental manipulation to describe aspects of the environment or features of a particular stimulus, such as its probability of occurring, when or where it may occur, or how intense it will be. A rich body of research in rodent models has shown that organisms consistently prefer predictable shocks and associated contexts, and that predictability ameliorates the negative effects of stress. Uncertainty is a broader and more diverse construct in the domain of decision-making , for example, uncertainty can be decomposed into distinct levels including sensory uncertainty, state uncertainty, rule uncertainty, and outcome uncertainty. Uncertainty better captures subjective aspects of ones internal state, and thus appears more frequently in the literature on human anxiety disorders, whereas unpredictability is used more frequently in laboratory studies with controlled conditions. While we discuss both constructs, our primary focus is on uncertainty, which is inextricably linked to the phenomenological experience of anxiety arising from unpredictable future events.

    What Might Indicate That Both Anxiety And Depression Are Present

    Traits that may signal the presence of both anxiety disorder and depression include:

    • Irrational worries or fears that wont go away
    • Physical symptoms, such as fatigue, headaches, rapid heartbeat, labored breathing or abdominal pain
    • Difficulty going to sleep or staying asleep
    • Changes in eating habits either too much or too little
    • Trouble remembering, making decisions or concentrating
    • Constant feelings of sadness or worthlessness
    • Loss of usual interest in activities or hobbies
    • Feeling often tired and cranky
    • Inability to relax and live in the moment
    • Suffering from panic attacks, including the sense of losing inner control2

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    Is Crying A Symptom Of Anxiety

    A 2016 study found that people with anxiety are more likely to find crying irrepressible though helpful in relieving their stress. Crying, however, is not usually a symptom of anxiety. Crying can be an indicator of fatigue and exhaustion, which are symptoms of anxiety. Other common symptoms of anxiety include chest pain, flushed skin, fast heart rate, nausea, dizziness, and difficulty breathing.

    To learn more, check out our piece, Different Types of Anxiety Disorders.

    If you believe you are living with an anxiety disorder or other mental illness, contact a licensed therapist for a diagnosis. You can also consider various treatment options and coping tactics for anxiety. They generally involve a combination of addressing beliefs that cause anxiety and practicing a healthy lifestyle that includes exercise and meditation.

    Talkspace articles are written by experienced mental health-wellness contributors they are grounded in scientific research and evidence-based practices. Articles are extensively reviewed by our team of clinical experts to ensure content is accurate and on par with current industry standards.

    Our goal at Talkspace is to provide the most up-to-date, valuable, and objective information on mental health-related topics in order to help readers make informed decisions.

    Articles contain trusted third-party sources that are either directly linked to in the text or listed at the bottom to take readers directly to the source.

    Not All Anxiety Is A Disorder

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    Everyone experiences anxiety and fear at times these are normal and helpful human emotions that help us deal with danger. However, some people experience excessive and irrational anxiety and worries that become ongoing and distressing, and that interfere with their daily lives. This may indicate an anxiety disorder. Often there appears to be no obvious or logical reason for the way the person feels. This may make an anxiety disorder even more worrying to the sufferer.

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    When Does Normal Anxiety Become A Mental Illness

    • May 26, 2017
    • 3 minute read

    Imagine a caveman returning from a hunt. He is dragging the heavy carcass of a wild boar behind him. As he nears the glowing cave where his brethren await him, he constantly peers around to ensure there are no more threats.

    If something attacked him now, it would be difficult to defend. He hasnt seen anything dangerous for an hour, yet his eyes continue to dart around. He checks his back every couple of seconds.

    Then he hears a rustle in a bush next to him. He reflexively thrusts his spear toward the noise.

    In its purest, primal state, anxiety is an emotion that keeps us alive and unharmed. Our ancestors needed it to avoid being eaten by wild animals. By worrying about threats ahead of time, they became prepared to fight or take flight when necessary. This helped them survive and eventually thrive.

    We may not have these kinds of threats in our daily lives, but this same anxiety still has practical uses. Worrying a little bit about potential mistakes or negative outcomes helps us be responsible. For example, when people have mild anxiety about meeting a deadline, they gain some motivation that helps them finish their work ahead of time. Once the work is over, the anxiety subsides.

    Mild, occasional anxiety is not something to treat or worry about. It is only part of normal neurological functioning.

    Behavioral And Cognitive Avoidance

    Avoidant behavior and thoughts, including worry, prevent anxious individuals from being exposed to evidence that might contradict negative predictions about the future,,. According to classic two-process theory,, exaggerated fear conditioning to environmental threat cues leads to operant learning of avoidance behavior to reduce fear. Whereas these processes are assumed to operate implicitly in animal models, the extension of this thinking to human anxiety disorders suggests that avoidance may further heighten threat expectancies under conditions of uncertainty. Because events that are avoided or worried about typically fail to occur, behavioral and cognitive avoidance tendencies are negatively reinforced and anxious individuals develop false beliefs that they prevented these negative outcomes.

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    The Relationship Between Anxiety And Depression

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    While anxiety is generally considered a high-energy state and depression a low-energy state, anxiety and depression are more closely related than you might think. A person with depression often experiences a lot of anxiety, possibly even to the extent of having panic attacks.1

    Anxiety disorders involve more than common nervousness and worry. They can cause terrifying fear about things other people wouldnt think twice about. Many people with anxiety disorders fully comprehend that their thoughts are irrational. But they still cant stop them. Feelings of losing inner control haunt them. This angst is one of the entry ways for depression.2

    What Is Separation Anxiety Disorder

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    This condition mostly happens to children or teens, who may worry about being away from their parents. Children with separation anxiety disorder may fear that their parents will be hurt in some way or not come back as promised. It happens a lot in preschoolers. But older children and adults who experience a stressful event may have separation anxiety disorder as well.

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    Anxietys Effects After Students Leave College

    Beyond the short-term effects of anxiety, the condition can have a long-term impact on college students, sometimes extending long after theyve graduated. The Mayo Clinic notes that generalized anxiety disorder can precede other mental health problems, or it may worsen a preexisting health condition, such as headaches and migraines, heart disease, and chronic pain.

    Additionally, anxiety can play a role in a persons recovery from another illness. Writing for Johns Hopkins Medicine, Una McCann, MD, describes how anxiety can impair a persons recovery from a heart attack by interfering with the patients prescribed medications or preventing sleep during recovery, among other complications. Anxiety disorders come with a high degree of fear and uncertainty, Dr. McCann writes. When this fear and uncertainty keep the heart attack or heart disease patient from following the advice and treatment plan of their cardiologist, it can have a major impact on recovery.

    Student Stress And Anxiety Nationally By The Numbers

    Despite the fact that depression and anxiety are treatable, many students are reluctant to admit they have a problem and to seek help.

    Case in point: Victoria Pae . During freshman year, she says, she felt overwhelmed by stress and anxiety, but she was afraid to seek help. Everyone was doing so much, everyone was so on top of their games, it seemed like they had it all together, says Pae, a double major in neuroscience and psychology, who as a high school student had done very well academically and in extracurricular activities. Youre seeing everyone excelling above you. And even though you have the ability to excel too, youre too scared of making a fool of yourself to actually try to do it.

    Pae found it hard to admit she had a problem. She kept her feelings of anxiety and being overwhelmed to herself. I didnt want to tell myself that I needed to get help, so I didnt, she says. I just told myself, its all in my head, get over it.

    A colleague of mine has started calling it the game face that students put on, that tells everybody else in the world, Im just fine, Im handling it, look at me juggling school, extracurricular activities, and work, says Katharine Mooney , director of Wellness & Prevention Services at Student Health Services. But thats not how theyre feelingthey feel really alone, isolated, that no one else feels like they do. And thats just not the case.

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