Featured in the Media24 & YOU Magazine, Dr Magula, a psychiatrist specializing in the maintenance of mental health answers frequently asked questions about anxiety.
When is anxiety classified as a disorder?
Anxiety on its own is an adaptive response or constellation of responses, signs and symptoms that the body experiences and can mostly be tolerated and does not last longer than the reason why it existed. In other words, when the perceived or actual danger is out of the way, the anxiety symptoms should normally resolve. When these symptoms are excessive, persistent, become more than can be tolerated and an individual becomes impaired and disabled in their personal, mental, social, academic and physical functioning because of them, then this response becomes a disorder.
The essential features of all anxiety disorders are excessive and enduring fear, anxiety and/or the avoidance of perceived threats either in the external (for example, social situations) or internal (for example, bodily sensations) environment. The avoidance of perceived threats is very crucial to these disorders as it is the one that will make someone socially isolate themselves from friends, family and colleagues or school mates, not cope at work and thus lead to excessive stress and poor coping mechanisms such that they may quit their jobs or be dismissed for poor performance, and for school going individuals, poor school performance, school refusal and dropping out can result.
There is not one but around 7 well known forms of anxiety disorders, namely:
- Separation anxiety disorder (excessive persistent worry about separation from a major attachment figure),
- Selective mutism (failure to speak in a specific social situation where there is an expectation of verbal communication)
- Specific phobia (excessive anxiety around specific objects or phenomenon like injection needle phobia, animals and dare I say, even fear of contracting corona virus)
- Social anxiety disorder (excessive discomfort around social interactions with concerns about being judged and embarrassed)
- Panic disorder (recurrent unexpected surges of intense fear with physical symptoms)
- Agoraphobia (marked fear about escaping or having panic attack in open and public spaces)
- Generalized anxiety disorder ( excessive worry and apprehension about a number of things, events and activities) and those that may be caused by medical conditions like cardiac diseases (myocardial infarction and angina) and respiratory diseases (asthma and chronic obstructive pulmonary diseases) and the use of substances (alcohol, cannabis or even excessive caffeine).
Each of these types of anxiety disorders has its own features that are unique only to that particular disorder and there are specific and varying features that a practitioner trained in diagnosing anxiety disorders can enquire into in order to identify the particular anxiety disorder at question. The disorders themselves can be weighed up in terms of severity from mild to severe.
Who is prone to developing an anxiety disorder?
There are certain clues that can make someone prone to developing an anxiety disorder. There is no consensus on these and evidence for each may vary per individual, their environment and the access that they have to help.
- These clues can be found within the individual’s body for example their genes (hinting that they could be inherited) and their brain circuit responses.
- Psychological for example how one’s temperament is and their interactions with their carers and peers especially withdrawn or inhibited temperaments, parent interactions that are characterized by over–involvement and negativity, and reduced peer relationships.
- Found in the environment and socially for example life stressors, adverse childhood experiences like physical and sexual abuse, parental separation and emotional maltreatment all increase the risk for one developing anxiety disorders. In addition, episodic life stressors (such as financial strain for example during this COVID-19 pandemic, family illness and divorce) can predict subsequent anxiety symptoms and diagnoses.
- Furthermore, the interaction of all these clues with one another for example the interactions of genes and the influence of the environment can also increase someone’s vulnerability to developing an anxiety disorder. Specifically, female sex and a family history of anxiety disorders have been consistently shown to render someone at risk for developing an anxiety disorder. Female sex almost doubles the risk for anxiety disorders.
- Children of individuals who have at least one anxiety disorder have a twofold to fourfold increased risk for anxiety disorders and having parents with anxiety and depression amplifies the risk of developing an anxiety disorder later in life.
- Our habits and lifestyle can also make us prone to developing a disorder like abusing and misusing substances and unfortunately, developing a medical illness like a cancer of the adrenal gland or having epilepsy can also put you at risk for developing an anxiety disorder.
In your opinion, are anxiety disorders on the increase and if so why? Also non-Covid related if so.
Anxiety disorders constitute the largest group of mental disorders in most societies and are amongst the leading cause of disability. Anxiety disorders may have always been present but not well diagnosed in the past due to poor knowledge about their existence or perhaps due to inadequate training of mental health experts to identify them. Now that there is an increase in awareness even before the COVID era, anxiety disorder diagnosis has been seen as increasing as well and this may reflect as an overall increase in these disorders but they have always been there, we are just identifying them more now.
Can anxiety disorders ever be prevented?
The onset of anxiety disorders occurs from childhood, adolescence or early adulthood and if untreated, they tend to continue into adulthood and can be chronic with worsening symptoms that last the individuals entire life if left untreated. Due to the complexities of determining the exact cause of each anxiety disorder on each individual and because there is no exact known cause for each, anxiety disorders cannot all be completely cured, and like a seasonal flu, if treated may go away to perhaps return after a variable amount of time due to new or persisting triggers. So when the match is lit once more by a stressor, the fire may burn again and the strength of the fire will be determined by the individual’s protective factors (early treatment, support) and their resilience (good insight to their returning anxiety disorder. However, certain measures can be put in place to prevent an individual who is prone to developing an anxiety from developing one.
Proper and accurate early detection of at risk patients with family history of anxiety disorders and depression and those who have been exposed to adverse life events. Measures to prevent development of anxiety disorders would include early detection of fears and worries in withdrawn and inhibited children and helping them overcome their fears and deal with them in a healthy manner, stimulating and promoting positive and helpful adaptive ways that will not later become an impairment to their function.
De-stigmatization can lead to better education and promote openness about the topic and that in itself can promote early reports and detection even at the community level as it will reduce shame and guilt for having such a disorder. If there’s anything we have learnt as a country, from winning the rugby world cup, having our very own taking the honor of Miss Universe title and the past many days of our country’s lockdown is that together we can go far as a country, united in caring for each one’s own and another’s mental state, being kind to another, loving one another as we do ourselves, the flattening of the anxiety disorder curve may well be imminent.
If you have any concerns about your mental well-being, do not hesitate to see a healthcare professional, such as Dr Magula.